Comparison of Hypertension in Migrant and Local Patients with Atherosclerotic Diseases: A Cross-Sectional Study in Shanghai, China.

Background: Hypertension and its complications represent major health problems worldwide and are distributed differently in different populations. This study aimed to reveal the differences between two populations of patients with hypertension who had atherosclerotic complications: local residents in and migrants to the city of Shanghai, China. Methods: We conducted a cross-sectional study among hospitalized patients with hypertension age 21-65 years in Pudong District. We compared the characteristics of local and migrant patients with hypertension, and analyzed the distribution and risk factors of atherosclerotic complications between these groups. Results: The proportion of young and uninsured patients with hypertension was higher among migrant than local participants. The rates of stroke (15.4% vs. 25.0%, p < 0.05) and coronary heart disease (8.6% vs. 11.7%, p < 0.05) were lower and the rates of other atherosclerotic diseases higher (8.5% vs. 7.9%, p = 0.429) among migrant than local participants. According to logistic regression analysis, age was an important risk factor in both the migrant and local groups for all three atherosclerotic complications investigated. Insurance, diabetes, and frequency of hospitalization could influence the incidence of atherosclerotic complications among local patients with hypertension. Among migrant patients, differences for sex, insurance, marital status, diabetes history, and frequency of hospitalization were not significant. Conclusions: Our study demonstrated differences in the characteristics, distribution, and risk factors of atherosclerotic complications among migrant and local patients with hypertension. Greater attention in needed for the increasing population of migrants.

Status of evidence-based chronic diseases prevention implementation in Shanghai, China: A qualitative study.

BACKGROUND: Given the rapid increase in chronic disease epidemics in developing countries and the lagging research and practice in evidence-based chronic diseases prevention (EBCDP), we evaluated the status of public health practitioners' implementation of EBCDP and its impeding factors in China, as well as made a comparison between China and the developed countries to encourage better utilisation of this new field of science in China. METHODS: We interviewed health practitioners and patients from various health institutions in China and conducted a literature review to assess the current status of EBCDP practice in developed countries and identify the contextual driving factors. RESULTS: China is in its initial stage of EBCDP practice, as it lacks evidence-based interventions. Moreover, health practitioners' awareness of EBCDP is inadequate. The lack of policy support, especially funding, has restricted the efficiency and quality of EBCDP in terms of its adoption, implementation, and maintenance. Currently, EBCDP practice is limited to the practitioners' spontaneous behaviours. The literature review showed that developed countries practising EBCDP did well in evidence development and awareness; however, much has yet to be explored regarding practitioners' adoption and implementation and the maintenance of evidence-based practice. The impeding factors in developed countries were related to individual (patients and physicians) and organisational factors (such as resources, leaders, and climate). CONCLUSION: To promote EBCDP practice in China, more evidence for effective chronic disease prevention programmes is needed, and multiple and flexible measures should be implemented for a successful transition to evidence-based practice.

Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China.

BACKGROUND: Reform of the health care system in China has prompted concerns about the utilization of mental health services. This study aims to compare the utilization of mental health services among inpatients in various types of health institutions in Shanghai (community health care centres, secondary general hospitals, tertiary general hospitals, and specialty hospitals). METHODS: Based on electronic health record (EHR) data, we extracted all of the mental hospitalization data from various types of public health institutions in Pudong New Area, Shanghai, China, from 2013 to 2016. The distribution of mentally ill inpatients and the possible factors contributing to the observed differences in these institutions were analysed. RESULTS: Specialty psychiatric hospitals in Pudong New Area, Shanghai, admitted more inpatients and treated in patients with more severe disorders (49.73%). However, those who were male (OR = 0.545), were elderly (OR = 20.133), had inferior insurance (urban social insurance for citizens: OR = 4.013; paying themselves, OR = 29.489), had a longer length of stay (OR = 1.001) and had lower costs (OR = 0.910) were more likely to choose community health centres than specialty hospitals. Those who preferred the secondary and tertiary hospitals to the specialty ones were more likely to be in the male, elderly, married, shorter length of stay and higher-cost groups. Notably, compared to those with urban social insurance for workers, those who had urban social insurance for citizens (OR = 3.136) or paid out-of-pocket (OR = 9.822) were significantly clustered in the tertiary hospitals rather than the specialty hospitals. CONCLUSIONS: Inpatients who were male, were older, had inferior insurance, had a longer length of stay and had lower costs preferred the elementary health services. However, the utilization of mental health care in high-tier institutions reflected defects, especially the fact that the current health insurance system does not adequately restrict patients' choices, and those who paid more tended to choose tertiary hospitals instead of professional specialty ones. We suggest that psychiatric services should be enhanced by instituting reforms, including public education, improved health insurance, a forceful referral system, and competency reinforcement for primary care physicians, to provide a more integrated mental health system.

Using the Risk Factors of Pancreatic Cancer and Their Interactions in Cancer Screening: A Case-Control Study in Shanghai, China.

BACKGROUND: The incidence of pancreatic cancer has increased annually, but the risk factors and their interactions are still unknown. OBJECTIVE: The aim of this study was to identify risk factors and the effects of their interactions on pancreatic cancer occurrence among patients in Shanghai, China. METHODS: We conducted a hospital-based case-control study. The case group consisted of pathologically diagnosed pancreatic cancer patients, and the control group consisted of a healthy population. The Pearson Chi-square test was used to compare the distribution frequencies of data between groups. Multivariate analysis and interaction analysis were conducted to explore possible risk factors and interactions between various variables. FINDINGS: Among the 4,821 recruited participants, 1,392 were pancreatic cancer patients and 3,429 were controls. Multivariate logistic analysis suggested that age (>50 years old) (AOR: 16.20 [95% CI 6.78; 38.69]), diabetes (AOR: 5.40 [95% CI 2.70; 10.80]), chronic pancreatitis (AOR: 27.43 [95% CI 2.14; 351.77]), smoking (AOR: 8.86 [95% CI 3.07; 25.58]), and family cancer history (AOR: 2.10 [95% CI 1.09; 8.56]) were the primary risk factors for pancreatic cancer. Interestingly, synergistic interactions between risk factors were found, especially between age and chronic pancreatitis (RERI = 447.93, API = 96.74%, SI = 32.78), age and smoking (RERI = 187.42, API = 94.97%, SI = 21.99), and diabetes and smoking (RERI = 14.39, API = 48.06%, SI = 1.99). CONCLUSIONS: Age, diabetes, chronic pancreatitis, smoking, and family cancer history have been verified as the primary risk factors for pancreatic cancer in this study. Moreover, the interaction effects between old age, diabetes, chronic pancreatitis, and smoking substantially increase the probability of the development of pancreatic cancer. Cancer screening should be conducted extensively among people with these multiple factors to improve the efficiency.