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1.
Inquiry ; 61: 469580231224823, 2024.
Article in English | MEDLINE | ID: mdl-38281114

ABSTRACT

Dramatic geographic variations in healthcare expenditures were documented by developed countries, but little is known about such variations under China's context, and what causes such variations. This study aims to examine variations of healthcare expenditures among small areas and to determine the associations between demand-, supply-factors, and per capita inpatient expenditures. This cross-sectional study utilized hospital discharge data aggregated within delineated hospital service areas (HSAs) using the small-area analysis approach. Linear multivariate regression modeling with robust standard errors was used to estimate the sources of variation of per capita inpatient expenditures across HSAs covering the years 2017 to 2019; the Shapley value decomposition method was used to measure the respective contributions of demand-, supply-side to such variations. Among 149 HSAs, demand factors explained most of the (87.4%) overall geographic variation among HSAs. With each 1% increase in GDP per capita and urbanization rate was associated with 0.099% and 0.9% increase in inpatient expenditure per capita, respectively, while each 1% increase in the share of females and the unemployment rate was associated with a 0.7% and 0.4% reduction in the per capita inpatient expenditures, respectively. In supply-side, for every 1 increase in hospital beds per 1000 population, the per capita inpatient expenditures rose by 2.9%, while with every 1% increase in the share of private hospitals, the per capita inpatient expenditures would decrease by 0.4%. With Herfindahl-Hirschman Index decrease 10%, the per capita inpatient expenditures would increase 1.06%. This study suggests demand-side factors are associated with large geographic variation in per capita inpatient expenditures among HSAs, while supply-side factors played an important role. The evaluation of geographic variations in per capita inpatient expenditures as well as its associated factors have great potential to provide an indirect approach to identify possibly existing underutilized or overutilized healthcare procedures.


Subject(s)
Delivery of Health Care , Health Expenditures , Female , Humans , Small-Area Analysis , Cross-Sectional Studies , Health Facilities
2.
BMJ Open ; 12(1): e051538, 2022 01 24.
Article in English | MEDLINE | ID: mdl-35074811

ABSTRACT

OBJECTIVES: To delineate hospital service areas (HSAs) using the Dartmouth approach in China and identify the hypothesised demand-side, supply-side and region-specific factors of health expenditure within HSAs. DESIGN: Population-based descriptive study. SETTING: We selected the metropolis of Chengdu, one of the three most populous cities in China as a case for the analysis, where approximately 16.33 million residents living. PARTICIPANTS: Individual-level in-patient discharge records (n=904 298) during the fourth quarter of 2018 (from 1 September to 31 December) were extracted from Sichuan Health Commission. Cases of non-residents of Chengdu were excluded from the datasets. METHODS: We conducted three sets of analyses: (1) apply Dartmouth approach to delineate HSAs; (2) use Geographic Information System (GIS)-based method to demonstrate health expenditure variations across delineated HSAs and (3) employ a three-level multilevel linear model to examine the association between health expenditure and demand-side, supply-side and region-specific factors. RESULTS: A total of 113 HSAs with a median population of 60 472 (ranging from 7022 to 827 750) was delineated. Total in-patient expenditure per admission varied more than threefold across HSAs after adjusting for age and gender. Apart from a list of demand-side factors, an increased number of physicians, healthcare facilities at higher levels and for-profit healthcare facilities were significantly associated with increased total in-patient expenditures. At the HSA level, the proportion of private healthcare facilities located in a single HSA was associated with increased total in-patient expenditure generated by that HSA, while the increased number of healthcare facilities in a HSA was negatively associated with the total in-patient expenditures. CONCLUSION: HSAs were delineated to help establish an accountable healthcare delivery system, which serves as local hospital markets to provide in-patient healthcare via connecting demanders with suppliers inside particular HSAs. Policy-makers should adopt HSAs to identify variations of total in-patient expenditures among different areas and the potential associated factors. Findings from the HSA-based analysis could inform the formulation of relevant health policies and the optimisation of healthcare resource allocations.


Subject(s)
Health Expenditures , Hospitals , China , Delivery of Health Care , Humans , Patient Discharge
3.
BMC Public Health ; 18(1): 909, 2018 07 24.
Article in English | MEDLINE | ID: mdl-30041632

ABSTRACT

BACKGROUND: The association between obesity and depression has been documented in previous systematic studies but remains controversial. Many prospective studies have focused on children and youth, and several studies have examined this relationship among older populations. This study of the changes in obesity status aimed to examine the association between depression and obesity among middle-aged and elderly adults in China. METHODS: The data originated from the follow-up survey (2011 and 2013-2015) of the China Health and Retirement Longitudinal Study (CHARLS) and included 3337 residents aged at least 45 years who completed a physical examination and were evaluated with the Center for Epidemiological Studies Depression Scale (CES-D-10), which assessed depressive symptoms. Obesity status was defined by body mass index (BMI) and waist circumference (WC) according to Chinese criteria. A time-dependent Cox proportional hazards model was used to estimate the relationship between obesity status and depressive symptoms. RESULTS: The rate of depression in men and women was 26.67 and 38.37%, respectively. Based on BMI, the proportion of the population that was overweight and obese was 28.07 and 9.26%, respectively, in males and 35.03 and 16.84%, respectively, in females. Males with obesity were less likely to suffer from depressive symptoms than males with a normal weight (ORHR = 0.506, 95% CI = 0.347~ 0.736). Based on WC, the proportion of abdominal obesity was 49.35% in males and 73.65% in females. Males with abdominal obesity were less likely to suffer from depressive symptoms than males without abdominal obesity (ORHR = 0.775, 95% CI = 0.644~ 0.933). CONCLUSION: Obesity is more likely to be associated with the onset of depression in males than in females. However, regardless of underweight or overweight status, the relationship between weight and depressive symptoms is negatively associated among females and males. In conclusion, both BMI and WC can be used as tools for examining the association between obesity and depression.


Subject(s)
Body Mass Index , Depression/epidemiology , Obesity/epidemiology , Waist Circumference , Aged , Asian People , China/epidemiology , Cohort Studies , Depression/complications , Depressive Disorder/complications , Depressive Disorder/epidemiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Obesity/complications , Obesity, Abdominal/complications , Obesity, Abdominal/epidemiology , Overweight , Proportional Hazards Models , Prospective Studies , Psychiatric Status Rating Scales , Retirement/psychology , Sex Factors , Surveys and Questionnaires , Thinness
4.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(4): 584-588, 2017 Jul.
Article in Chinese | MEDLINE | ID: mdl-28752979

ABSTRACT

OBJECTIVE: To determine the relationship between sleep duration and abdominal obesity in elderly in china. METHODS: Data were drawn from the 2013 China Health and Retirement National Investigation (China Health and Retirement Longitudinal Study, CHARLS). The prevalence of abdominal obesity in the elderly who had a normal range of sleep duration was compared with those who had a shorter or longer sleep duration using Chi-square tests and binary logistic regression models. RESULTS: Higher odds of abdominal obesity were found in the elderly male with a shorter (OR=1.627, 95%CI: 1.286-2.060, P<0.05) or longer (OR=1.499, 95%CI: 1.009-2.228, P<0.001) sleep duration, compared with those with a normal range of sleep duration. Statistical significances were found in the prevalence of abdominal obesity among those with different characteristics in education, smoking, chronic conditions, and social participation. CONCLUSION: Both long and short sleep durations are associated with increased risk of obesity, which is more evident in older men. Bad living habits and mental state will increase the risk of abdominal obesity.


Subject(s)
Obesity, Abdominal , Sleep , Aged , China , Humans , Longitudinal Studies , Male , Time Factors
5.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(2): 263-267, 2017 Mar.
Article in Chinese | MEDLINE | ID: mdl-28612539

ABSTRACT

OBJECTIVES: To investigate social support for elderly in urban and rural settings, and determine its role in physical and psychological health of the elderly populations. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Physical health was measured by the ADL/IADL scale. Mental health was measured by the CES-D scale. Family support included financial support, daily care and emotional care. Binary logistic models were established to test the associations between family support and physical and mental health. RESULTS: For the rural elderly people, financial support from children was positively associated with physical health (P <0.05); whereas, emotional comfort from children was associated with better mental health (P <0.01). Daily care from children was associated with physical and mental health of the elderly in both urban and rural settings (P <0.01). CONCLUSION: An urban-rural difference exists in the role of family support in physical and mental health of the elderly. Rural elderly people are more dependent on family support than their urban counterparts. Social support needs to be strengthened to reduce the urban-rural gap. Meanwhile, family support will continue to play a role in improving the health of elderly populations.


Subject(s)
Mental Health , Rural Population , Social Support , Urban Population , Aged , Child , China , Family , Humans , Longitudinal Studies
6.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(2): 268-271, 2017 Mar.
Article in Chinese | MEDLINE | ID: mdl-28612540

ABSTRACT

OBJECTIVES: To determine the prevalence of arthritis in middle- and old-aged populations in China and associated factors. METHODS: Data were drawn from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Binary logistic regression analyses were performed to examine the associations of arthritis with social economic status (age, gender, areas, education), comorbidity (hypertension, dyslipidaemia, diabetes, cancer, chronic lung disease, liver disease, heart disease, stroke, kidney disease, digestive disease, asthma), lifestyle (smoking, drinking, sleeping) and mental health (depression symptoms). RESULTS: About 30.8% of respondents reported arthritis. Those who resided in rural areas, drank regularly, and had depression symptoms, hypertension, chronic lung disease, liver disease, heart disease, stroke, kidney disease, digestive disease and asthma had higher prevalence of arthritis than others. CONCLUSION: The prevalence of arthritis is high in middle- and old-aged populations in China, which deserves increasing attention.


Subject(s)
Arthritis/epidemiology , Aged , China/epidemiology , Comorbidity , Humans , Longitudinal Studies , Middle Aged , Prevalence , Risk Factors
7.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(3): 455-459, 2017 May.
Article in Chinese | MEDLINE | ID: mdl-28616925

ABSTRACT

OBJECTIVES: To investigate the perceptions and attitudes of Chengdu residents toward "medical and aged care" integrated models and associated factors. METHODS: A cross-sectional questionnaire survey was conducted in 935 residents who were 45 years or older in 8 communities in Chengdu. Descriptive analyses and logistic binary regression analyses were performed. RESULTS: About 91.1% of respondents preferred self-care and family support, and only 8.9% preferred community and institutional care. About 84.9% of respondents reported no knowledge about the "medical and aged care" integrated models, and 15.1% had some basic understanding of the integrated care models. Middle-aged respondents were more likely to understand the integrated care models than their older counterparts, with 21.7% willing to endorse the integrated care models. The logistic regression analyses showed that age, educational attainment, marital status, chronic illness, available financial support, and knowledge and awareness were associated with the choice. CONCLUSIONS: Chengdu residents have low level of knowledge and awareness of the "medical and aged care" integrated models. Public education is needed to promote the new aged care models.


Subject(s)
Aging , Delivery of Health Care, Integrated/organization & administration , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Humans , Middle Aged , Surveys and Questionnaires
8.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 47(2): 248-52, 2016 Mar.
Article in Chinese | MEDLINE | ID: mdl-27263304

ABSTRACT

OBJECTIVE: To determine differences of self-rated health in elderly people across geographic regions of China, and to identify factors influencing self-rated health of elderly. METHODS: Ordered logistic modeling was performed using the China Health and Retirement Longitudinal Study (CHARLS) data in 2013. RESULTS: Elderly people resided in Eastern China had better self-rated health than their counterparts residing in Middle (partial regression coefficient 0.252, P < 0.01) and Western (partial regression coefficient 0.338, P < 0.001) China. Sex, residency, education, per capita consumption expenditure, smoking and drinking, social participation, chronic diseases, and life satisfaction were identified as associated with self-rated health of elderly. CONCLUSION: There are regional differences in self-rated health of elderly. Policy priorities should be given to Middle and Western China, with more health resources being allocated to those regions. Regional economic and educational inequalities need to be addressed. Healthy lifestyle should be promoted.


Subject(s)
Diagnostic Self Evaluation , Health Status , Aged , China , Geography , Humans , Logistic Models , Longitudinal Studies
9.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 47(5): 763-767, 2016 Sep.
Article in Chinese | MEDLINE | ID: mdl-28598095

ABSTRACT

OBJECTIVES: To determine the prevalence and determinants of depressive symptoms in the mid- and old-aged people in China. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study (CHARLS),which containthe Center Epidemiologic Studies-Depression scale(CES-D). Binary logistic regression models were developed to identify factors associated with the prevalence of depression symptoms. These included socio-economic status of the respondents (gender, age, education),health-related factors (chronic diseases, disability, accident injury, and fall in recent two years),and family events over the past two years (deaths of a parent, spouse or child). RESULTS: About 31.9% of respondents had depressive symptoms, with a mean CES-D score of 8.0±4.9.Women and those who were younger than 75 years, widowed, resided in a rural area, had low levels of education, and suffered from multiple chronic conditions were more likely to have depressive symptoms than the others. CONCLUSIONS: High prevalence of depressive symptoms in the mid- and old-aged population in China is evident, which is associated with the health and socio-economic status of the population.


Subject(s)
Depression/epidemiology , Social Class , Aged , China/epidemiology , Female , Humans , Longitudinal Studies , Male , Prevalence , Psychiatric Status Rating Scales , Risk Factors
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