Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study.

Background: Hospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. However, little is known about the effects of differential cost-sharing in health insurance schemes on choice of hospital tiers. Methods: In a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009-2017. Analyses were performed separately in urban areas (stroke: n = 20,302; IHD: n = 19,283) and rural areas (stroke: n = 21,130; IHD: n = 17,890), using conditional logit models and adjusting for individual socioeconomic and health characteristics. Findings: About 64-68% of stroke and IHD cases in urban areas and 27-29% in rural areas chose tier 3 hospitals. In urban areas, higher reimbursement rates in each tier and lower tier 3 deductibles were associated with a greater likelihood of choosing their respective hospital tiers. In rural areas, the effects of cost-sharing were modest, suggesting a greater contribution of other factors. Higher socioeconomic status and greater disease severity were associated with a greater likelihood of seeking care in higher tier hospitals in urban and rural areas. Interpretation: Patient choice of hospital tiers for treatment of stroke and IHD in China was influenced by differential cost-sharing in urban areas, but not in rural areas. Further strategies are required to incentivise appropriate health seeking behaviour and promote more efficient hospital use. Funding: Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and National Natural Science Foundation of China.

Trends in health service needs, utilization, and non-communicable chronic diseases burden of older adults in China: evidence from the 1993 to 2018 National Health Service Survey.

BACKGROUND: Aging is associated with an increased prevalence of non-communicable chronic diseases (NCDs), functional impairments, and diverse demands for health services. This study analyzed the trends in older adults' needs and utilization of health services from 1993 to 2018 in China, as well as chronic disease-related economic burdens. METHODS: The research data were collected from the six cross-sectional National Health Service Survey (NHSS), implemented every 5 years from 1993 to 2018. A multi-stage stratified random cluster sampling method has been adopted in the NHSS. The data on the older population's socio-economic characteristics, health service needs, and utilization were collected from the 6 waves National Health Service Survey (NHSS) 1993-2018. In the 2013 and 2018 NHSSs, EQ-5D-3L and visual analogue scale were used to evaluate the health condition. And the prevalence of NCDs and related Out-of-pocket (OOP) expenditures were collected. Functional dependency and impairment were collected in 2018. The Katz Activities of Daily Living scale was used to evaluate six functions, including self-feeding, dressing, bathing, transferring, toilet hygiene, and controlling bowel movements. RESULTS: The two-week morbidity rate and prevalence of NCDs showed a rapid upward trend in older adults. With the development of health system reform and universal health insurance coverage, older adults' two-week medical consultation rate increased from 25.6% in 1993 to 40.1% in 2018, and the hospitalization rate rose from 6.1% to 24.9%. The difference in health service needs and utilization between urban and rural areas decreased, and the hospitalization rate in rural areas (26.3%) exceeded that in urban areas (23.6%) for the first time in 2018. Functional independence become more severe as aged. The proportion of severe functional impairment was 6.9% and 2% in the group aged 80 or over and group 70-79 years, respectively. Regarding disability status, 32.5% had hearing problems and 31.4% had visual impairment. The highest prevalence rates of NCDs in older adults were found in hypertension (36.9%), followed by diabetes (10.6%), cerebrovascular disease (5.4%), ischemic heart disease (4.5%), and intervertebral disc disease (4.2%). The average annual OOP expenditures attributed to NCDs increased from ¥2481.8 RMB in 2013 to ¥8255.9 RMB in 2018 for older adults. About 90.7% of older adults prefer to live in the residential community, leading to the demands for preventive healthcare (30.4%), medical treatment (14.1%), and elderly education (8.6%). CONCLUSION: The elevated risks of age-related impairments and chronic morbidities, and increased demands for preventive healthcare are critical public health issues. Policymakers should strengthen primary healthcare and move towards integrated delivery to improve access and quality of care for older adults. The integration of healthcare and social security constitutes an adaptive trend in meeting the multi-level demands of an aging society.

Digital Quantification of Tumor Cellularity as a Novel Prognostic Feature of Non-Small Cell Lung Carcinoma.

Non-small cell lung carcinoma is currently staged based on the size and involvement of other structures. Tumor size may be a surrogate measure of the total number of tumor cells. A recently revised reporting system for adenocarcinoma incorporates high-risk histologic patterns, which may have increased cellular density. Modern digital image analysis tools can be utilized to automate the quantification of cells. In this study, we tested the hypothesis that tumor cellularity can be used as a novel prognostic tool for lung cancer. Digital slides from The Cancer Genome Atlas lung adenocarcinoma (ADC) data set (n = 213) and lung squamous cell carcinoma (SCC) data set (n = 90) were obtained and analyzed using QuPath. The number of tumor cells was normalized with the surface area of the tumor to provide a measure of tumor cell density. Tumor cellularity was calculated by multiplying the size of the tumor with the cell density. Major histologic patterns and grade were compared with the tumor density of the lung ADC and lung SCC cases. The overall and progression-free survival were compared between groups of high and low tumor cellularity. High-grade histologic patterns in the ADC and SCC cases were associated with greater tumor densities compared with low-grade patterns. Cases with lower tumor cellularity had improved overall and progression-free survival compared with cases with higher cellularity. These results support tumor cellularity as a novel prognostic tool for non-small cell lung carcinoma that considers tumor stage and grade elements.

Individualized prediction of chronic kidney disease for the elderly in longevity areas in China: Machine learning approaches.

Background: Chronic kidney disease (CKD) has become a major public health problem worldwide and has caused a huge social and economic burden, especially in developing countries. No previous study has used machine learning (ML) methods combined with longitudinal data to predict the risk of CKD development in 2 years amongst the elderly in China. Methods: This study was based on the panel data of 925 elderly individuals in the 2012 baseline survey and 2014 follow-up survey of the Healthy Aging and Biomarkers Cohort Study (HABCS) database. Six ML models, logistic regression (LR), lasso regression, random forests (RF), gradient-boosted decision tree (GBDT), support vector machine (SVM), and deep neural network (DNN), were developed to predict the probability of CKD amongst the elderly in 2 years (the year of 2014). The decision curve analysis (DCA) provided a range of threshold probability of the outcome and the net benefit of each ML model. Results: Amongst the 925 elderly in the HABCS 2014 survey, 289 (18.8%) had CKD. Compared with the other models, LR, lasso regression, RF, GBDT, and DNN had no statistical significance of the area under the receiver operating curve (AUC) value (>0.7), and SVM exhibited the lowest predictive performance (AUC = 0.633, p-value = 0.057). DNN had the highest positive predictive value (PPV) (0.328), whereas LR had the lowest (0.287). DCA results indicated that within the threshold ranges of ~0-0.03 and 0.37-0.40, the net benefit of GBDT was the largest. Within the threshold ranges of ~0.03-0.10 and 0.26-0.30, the net benefit of RF was the largest. Age was the most important predictor variable in the RF and GBDT models. Blood urea nitrogen, serum albumin, uric acid, body mass index (BMI), marital status, activities of daily living (ADL)/instrumental activities of daily living (IADL) and gender were crucial in predicting CKD in the elderly. Conclusion: The ML model could successfully capture the linear and nonlinear relationships of risk factors for CKD in the elderly. The decision support system based on the predictive model in this research can help medical staff detect and intervene in the health of the elderly early.

Factors influencing smoking behaviour of online ride-hailing drivers in China: a cross-sectional analysis.

BACKGROUND: Online ride-hailing is a fast-developing new travel mode. However, tobacco control policies on its drivers remain underdeveloped. This study aims to reveal the status and determine the influencing factors of ride-hailing drivers' smoking behaviour to provide a basis for the formulation of tobacco control policies. METHODS: We derived our cross-sectional data from an online survey of full-time ride-hailing drivers in China. We used a survey questionnaire to collect variables, including sociodemographic and work-related characteristics, health status, health behaviour, health literacy and smoking status. Finally, we analysed the influencing factors of current smoking by conducting chi-square test and multivariate logistic regression. RESULTS: A total of 8990 ride-hailing drivers have participated in the survey, in which 5024 were current smokers, accounting to 55.9%. Nearly one-third of smokers smoked in their cars (32.2%). The logistic regression analysis results were as follows: male drivers (OR = 0.519, 95% CI [0.416, 0.647]), central regions (OR = 1.172, 95% CI [1.049, 1.309]) and eastern regions (OR = 1.330, 95% CI [1.194, 1.480]), working at both daytime and night (OR = 1.287, 95% CI [1.164, 1.424]) and non-fixed time (OR = 0.847, 95% CI [0.718, 0.999]), ages of 35-54 years (OR = 0.585, 95% CI [0.408, 0.829]), current drinker (OR = 1.663, 95% CI [1.526, 1.813]), irregular eating habits (OR = 1.370, 95% CI [1.233, 1.523]), the number of days in a week of engaging in at least 10 min of moderate or vigorous exercise ≥3 (OR = 0.752, 95% CI [0.646, 0.875]), taking the initiative to acquire health knowledge occasionally (OR = 0.882, 95% CI [0.783, 0.992]) or frequently (OR = 0.675, 95% CI [0.591, 0.770]) and underweight (OR = 1.249, 95% CI [1.001, 1.559]) and overweight (OR = 0.846, 95% CI [0.775, 0.924]) have association with the prevalence of current smoking amongst online ride-hailing drivers. CONCLUSION: The smoking rate of ride-hailing drivers was high. Sociodemographic and work-related characteristics and health-related factors affected their smoking behaviour. Psychological and behavioural interventions can promote smoking control management and encourage drivers to quit or limit smoking. Online car-hailing companies can also establish a complaint mechanism combined with personal credit.

Latin American Immigration, Maternal Education, and Approaches to Managing Children's Schooling in the United States.

Concerted cultivation is the active parental management of children's educations that, because it differs by race/ethnicity, nativity, and socioeconomic status, plays a role in early educational disparities. Analyses of the Early Childhood Longitudinal Study-Kindergarten Cohort (n = 10,913) revealed that foreign-born Latina mothers were generally less likely to engage in school-based activities, enroll children in extracurricular activities, or provide educational materials at home when children were at the start of elementary school than were U.S.-born White, African American, and Latina mothers, in part because of their lower educational attainment. Within the foreign-born Latina sample, the link between maternal education and the three concerted cultivation behaviors did not vary by whether the education was attained in the United States or Latin America. Higher maternal education appeared to matter somewhat more to parenting when children were girls and had higher achievement.

Analysis of inpatient bed allocation equity and utilization in the city community health service center of China.

The objective of this study was to examine the inpatient bed (IB) allocation equity and utilization in Chinese city community health service centers (CHSCs). The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms of IB allocation quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China / 华中科技大学学报（医学）（英德文版）

The objective of this study was to examine the inpatient bed(IB)allocation equity and utilization in Chinese city community health service centers(CHSCs).The data were derived from the Baseline Survey of National City Community Health Service System Building Project,which was conducted in 1917 CHSCs in 28 cities in 2007.The IB allocation was analyzed in terms of IB allocation quantity and distribution equity,and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients.The results showed that 49.3% of the CHSCs were equipped with IB; averagely,there were 45 IBs per CHSC,0.94 IBs per 1000 people,and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days.The conclusions were that IB allocation among the population was equitable,but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole,thus inpatient service was not the main health service for Chinese CHSCs.

Cross-sectional study of endodontic treatment in an Australian population.

The quality and technical standard of Australian endodontic treatment is generally unknown. Two hundred and forty-three patients from a metropolitan dental hospital were radiographically assessed for quality of root canal therapy. Total teeth examined were 5647 with 499 teeth (8.84%) being root-filled. Teeth were scored using Ørstavik's Periapical Index. Periapical Index scores indicating a healthy periapical state were found in 392 root-filled teeth (78.56%) and those indicative of periapical disease in 107 root-filled teeth (21.43%). Of the 499 root-filled teeth, 149 (29.9%) were adequate in terms of length, with 120 teeth (80.5%) of these healthy. Three hundred and fifteen teeth (63.1%) were filled short with 271 (86.0%) classified as healthy. Thirty-five teeth (7.0%) were filled long with only one tooth (2.9%) in this category deemed healthy. Four hundred and fifty-nine teeth (92.0%) were adequate in density, with 365 teeth (79.5%) being healthy. Forty teeth (8.0%) showed inadequate density with 27 (67.5%) being healthy. One hundred and forty-five teeth (29.1%) were adequate in length and density with 117 teeth (80.7%) deemed healthy. A significant statistical correlation between root filling quality and periapical status was not found. Factors, such as the coronal restoration quality, should be further investigated.

Chinese American adolescents' perceptions of the language brokering experience as a sense of burden and sense of efficacy.

Children of immigrants who do translations and who interpret for others using their heritage language and English are known as language brokers. Although prior research suggests that children of immigrants' perceptions of the language brokering experience vary greatly-from feeling a sense of efficacy to feeling a sense of burden-what remains unanswered in the literature is identification of the antecedents and processes that help to explain the varying psychological experience of language brokers. Using data from a two-wave prospective longitudinal study of 256 Chinese American adolescents, the present study tested potential mechanisms that may be responsible for adolescents' perceptions of the language brokering experience as a sense or burden or sense of efficacy. The results demonstrate that adolescents' Chinese orientation sets in motion a family process that is linked to variations in the perceptions of adolescents' language brokering experience. Adolescents who are more Chinese oriented have a stronger sense of familial obligation, and these adolescents are more likely to perceive that they matter to their parents. Adolescents' perceived sense of mattering to parents, in turn, is associated positively with a sense efficacy, and negatively with a sense of burden as language brokers. Those adolescents who are less Chinese oriented have a weaker sense of familial obligation, and these adolescents are more likely to feel a sense of alienation from their parents. Adolescents' sense of perceived alienation from parents, in turn, is associated with a sense of burden as language brokers. Implications for developing interventions for children who act as language brokers for their parents are discussed.