Features of gastric cancer by anatomic subsite in northern China: A multi-center Health Science Report database study.

BACKGROUND: The features of gastric cancer based on the anatomic site remain unknown in northern China patients. AIM: To analyze gastric cancer features and associated trends based on the anatomical site in northern China patients. METHODS: This cross-sectional study used incident gastric cancer case data from 10 Peking University-affiliated hospitals (2014 to 2018). The clinical and prevailing local features were analyzed. RESULTS: A total of 10709 patients were enrolled, including antral (42.97%), cardia (34.30%), and stomach body (18.41%) gastric cancer cases. Cancer in the cardia had the highest male:female ratio, proportion of elderly patients, and patients with complications, including hypertension, diabetes, cerebrovascular, and coronary diseases (P < 0.001). gastric cancer involving the antrum showed the lowest proportion of patients from rural areas and accounted for the highest hospitalization rate and cost (each P < 0.001). The proportion of patients with cancer involving the cardia increased with an increase in the number of gastroesophageal reflux disease cases during the same period (P < 0.001). Multivariate analysis revealed that tumor location in the cardia increased the risk of in-hospital mortality (P = 0.046). Anatomical subsite was not linked to postoperative complications. CONCLUSION: The features of gastric cancer based on the anatomical site differ between northern China and other regions, both globally and within the country. Social factors may account for these differences and should affect policy-making and clinical practice.

Changing trends of hospitalisation of liver cirrhosis in Beijing, China.

OBJECTIVE: To examine if the hospitalisation trends of liver cirrhosis are changing with the changes of risk factors of the disease in China. DESIGN: Secondary analysis of hospitalisation records in the 31 top-ranking hospitals in Beijing. RESULTS: Between 2006 and 2010, hospitalisation from viral hepatitis cirrhosis (VHC) decreased by 10% (95% CI=5-14%, p<0.001), but non-viral hepatitis cirrhosis (NVHC) and alcoholic cirrhosis (AC) increased by 35% (26-46%, p<0.001) and 33% (19%- 47%, p<0.001), respectively. The age patterns of hospitalisation varied with different types of liver cirrhosis. The hospitalisation risks for patients with VHC and AC were significantly high in the age groups 40-49 and 50-59 years, but risks for those with NHVC were high in all age groups of 40 years or above. Overall male-to-female hospitalisation ratios for VHC, NVHC and AC were 2.71, 1.14 and 59.9, respectively. The sex ratio became smaller with time from 2006 to 2010 in hospitalised patients with VHC, but it substantially increased in those with NVHC during the same period. CONCLUSIONS: Hospitalisation rates for liver cirrhosis in Beijing are changing with time. The changes of viral hepatitis infection and alcohol consumption in the general population may cause these changes.

Cardiovascular disease and hip fracture among older inpatients in Beijing, China.

OBJECTIVES: To examine the associations between cardiovascular disease (CVD) and hip fracture and to determine if these associations are attributable to hypertensive disease. METHODS: Data were obtained from 2006-2010 hospitalization summary reports of 31 tertiary hospitals in Beijing, China. This study included 864,408 inpatients aged ≥55 years. Occurrence rate of hip fracture was based on the first-listed ICD-10 codes (S72.0, S72.1, and S72.2) and of CVD as comorbidities were based on the second- to the eighth-listed ICD-10 codes (I00-I99). RESULTS: The occurrence rate of hip fracture is 53% higher among older inpatients with a diagnosis of CVD than those without (RR = 1.53, 95% CI 1.47-1.60). Those with hip fracture were more likely to have hypertensive or cerebrovascular disease, with the risk ranging from 1.34 to 1.70. Compared with those without hip fracture, the occurrence rate of overall CVDs increased by 80%, 83%, and 16% among hip fracture patients aged 55-64, 65-79, and ≥80 years. In addition, hypertensive disease did not modify the association between cerebrovascular disease and hip fracture. CONCLUSION: CVD was positively associated with hip fracture, and the associations observed in this sample of Chinese inpatients were similar to those reported from cohort studies conducted in the European populations.

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001), from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.