Impact of reimbursement program on liver-related mortality in patients with chronic hepatitis B in Beijing, China.

OBJECTIVE: Since July 1, 2011 antiviral therapy for hepatitis B virus infection has been listed as a reimbursable expense for medical insurance in Beijing. This study aimed to assess the impact of this program on liver-related death for patients with chronic hepatitis B (CHB). METHODS: Profiles of patients with CHB discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. Liver-related deaths in these patients occurring between January 2008 and December 2017 were retrieved by linking them to the death certification database. Liver-related mortality (number of deaths divided by the observed person-years) before and after this program was launched was calculated and compared. A Poisson regression was performed to assess the strength of association (risk ratio [RR]) between the reimbursement program and liver-related mortality. RESULTS: Information on 35 943 discharged patients (17 114 patients with non-cirrhotic and 18 829 with compensated cirrhotic CHB) was retrieved. Altogether 3 832 liver-related deaths during the 190 695 person-years were observed. After the reimbursement program was launched, liver-related mortality per 100 person-years dropped from 0.38% to 0.16% for patients with non-cirrhotic CHB, and from 4.03% to 3.39% for those with compensated cirrhosis. The program was associated with a lower risk of developing liver-related death for patients with non-cirrhotic CHB (RR 0.40, 95% confidence interval [CI] 0.30-0.52) and those with compensated cirrhosis (RR 0.84, 95% CI 0.78-0.89). CONCLUSION: Coverage of antiviral therapy by basic medical insurance reduced the risk of developing liver-related death for patients with non-cirrhotic and with compensated cirrhotic CHB.

[Decomposition of life expectancy among permanent residents of Beijing, 2000 - 2010].

OBJECTIVE: To analyze the change of life expectancy and the impact of mortality by age and causes of death on this issue among permanent residents of Beijing. METHODS: Abridged Life Table and Arriaga method were used to calculate and to decompose the changes on life expectancy by age and causes of death in 2000 - 2010. RESULTS: From 2000 - 2010, life expectancy under this studied population had an increase of 3.35 years. Most part of the increases (44.27%, 1.48 years) within the last 10 years could be explained by the decrease of mortality in the population at age ≥ 80. Both cerebrovascular and heart diseases were contributing the most to the increment of life expectancy while mortality of malignant tumors appeared a negative contributor to this increment. CONCLUSION: From 2000 to 2010, increment in life expectancy contributed to the decrease of mortality in the elderly and the decrease of mortalities on both cardio- and cerebro-vascular diseases. The decrease of life expectancy was mainly due to the increase of mortality related to malignant tumors.

Assessing heat-related mortality risks in Beijing, China.

OBJECTIVE: To obtain the exposure-response relationship for temperature and mortality, and assess the risk of heat-related premature death. METHODS: A statistical model was developed using a Poisson generalized linear regression model with Beijing mortality and temperature data from October 1st, 2006 to September 30th, 2008. We calculated the exposure-response relationship for temperature and mortality in the central city, and inner suburban and outer suburban regions. Based on this relationship, a health risk model was used to assess the risk of heat-related premature death in the summer (June to August) of 2009. RESULTS: The population in the outer suburbs had the highest temperature-related mortality risk. People in the central city had a mid-range risk, while people in the inner suburbs had the lowest risk. Risk assessment predicted that the number of heat-related premature deaths in the summer of 2009 was 1581. The city areas of Chaoyang and Haidian districts had the highest number of premature deaths. The number of premature deaths in the southern areas of Beijing (Fangshan, Fengtai, Daxing, and Tongzhou districts) was in the mid-range. CONCLUSION: Ambient temperature significantly affects human mortality in Beijing. People in the city and outer suburban area have a higher temperature-related mortality risk than people in the inner suburban area. This may be explained by a temperature-related vulnerability.

[The epidemiology of out-of-hospital deaths due to acute coronary events in young Beijing adults].

OBJECTIVES: To explore the characteristics of status and different populations of prehospital death associated with acute coronary events among young adults in Beijing. METHODS: Data of acute coronary events of hospitalization or death were obtained from the Hospital Discharge Information System from Beijing Public Health Information Center and Death Register System from Beijing Center for Disease Control in Beijing. The total case fatality rate of acute coronary events and proportion of prehospital coronary heart disease (CHD) death were compared upon gender, area, occupation and marital status among people aged between 25 - 45 years old. RESULTS: A total of 3489 cases were identified during 2007 to 2009 with acute coronary events (male: 3183, female: 306), with a mean age of (40.5 ± 4.3) years old. The 3-years' overall mortality was 26.0%, with female's higher than male's (51.0% vs 23.6%, P < 0.05); and it was higher in rural area than in urban areas (28.9% vs 22.9%, P < 0.05). Ninety-five percent of death due to acute coronary events occurred prehospital, with the proportion of 95.2% in male and 94.2% in female. Among the people with different occupations, self-employed people had the highest rate of prehospital death. Majority of prehospital deaths (64.8%) occurred at home. CONCLUSION: More than 90% of deaths caused by acute coronary events among young adults aged between 25-45 years old occurred before been admitted into hospital, and the site of prehospital deaths was mainly at home.

[Surveillance on the incidence of acute coronary events in the permanent residents of Beijing aged 25 years and more from 2007 to 2009].

OBJECTIVE: To survey the incidence of acute coronary events and its trend in three years, and explore the distribution of the incidence across Beijing residents aged 25 years and more from 2007 to 2009. METHODS: The present study incorporated and linked the routinely collected data from the Hospital Discharge Information System and Cause of Death Register System in Beijing, estimated the incidence of acute coronary events, and analyzed the distribution of the incidence across gender, age groups and regions. Acute coronary event was defined as non-fatal myocardial infarction and death from coronary heart disease. Numbers of residents by age, gender and area were obtained from the Beijing Statistics Bureau. RESULTS: A total of 68 390 acute coronary events were identified among permanent residents of Beijing aged 25 years and more from 2007 to 2009. The age-standardized incidence was 166.4 per 100 000 people in overall population, with 218.5 in males and 115.2 in females. The age-standardized incidence was 144.3, 154.7, and 195.8 per 100 000 people in urban, suburban, and exurban area, respectively. The incidence was the highest in Huairou district (263.8 per 100 000), while was the lowest in Haidian district (121.5 per 100 000). The age-standardized incidence was 158.4, 169.4, and 171.2 per 100 000 in 2007, 2008, and 2009, respectively. The age-standardized incidence increased by 8.1% in 2009 compared to 2007, increase in men (11.1%) was greater than in women (2.5%). The incidence increased significantly with age in each year. The incidence raised by 30.3% in 2009 compared to 2007 for men aged 35 - 44 years. In 2009, the incidence was 146.7, 155.9, and 207.4 per 100 000 people in urban, suburban, and exurban area, respectively. The rates increased by 3.2% in both urban and suburban areas, and 16.4% in exurban areas in 2009 compared to 2007. CONCLUSION: The incidence of acute coronary events increased from 2007 to 2009 among the permanent residents of Beijing aged 25 years and over, especially in young men, and people living in the exurban areas.

[Characteristics of out-of-hospital acute coronary heart disease deaths of Beijing permanent residents at the age of 25 or more from 2007 to 2009].

OBJECTIVE: To analyze the characteristics of out-of-hospital acute coronary heart disease (CHD) deaths in Beijing permanent residents at the age of 25 or more from 2007 to 2009. METHODS: We analyzed the gender, age, geographical distribution, occupation, marital status and the extent of different education characteristics of out-of-hospital acute CHD deaths of the Beijing permanent residents at the age of 25 or more from 2007 to 2009 using the mortality information database from the Beijing Vital Registration Monitoring System. RESULTS: Of the total 41 732 acute CHD deaths, 30 159 (72.27%) died out of hospital and out-of-hospital mortality was 2.61 times higher than in-hospital mortality. Majority out-of-hospital death occurred in males (72.30%, 16 068/22 224), in 25 - 34 years old people (91.75%, 89/97), in residents living in remoter suburbs and counties (82.43%, 13 513/16 393), in rural population (89.50%, 10 017/11 192), in non-marital single (80.76%, 592/733) and in people less than five-years of schooling (83.95%, 11 388/13 565). Most out-of-hospital acute CHD death occurred at home (78.80%, 23 765/30 159). CONCLUSIONS: Out-of hospital acute CHD mortality is high in Beijing permanent residents at the age of 25 and over from 2007 to 2009. Male, 25 - 34 years old, living in outer suburbs and counties, rural population, non-marital single, and less education years are major risk factors for out-of-hospital acute CHD death.

[Analysis of the quality of notifiable infectious disease report in Beijing medical treatment organizations].

OBJECTIVE: To evaluate the quality of the infectious diseases reporting via network in Beijing hospitals and to filtrate factors that affect the reporting quality. METHODS: We collected 5536 infectious disease cases randomly and investigated 52 medical treatment organizations. Information was collected by field questionnaire survey, interview and gathering routine reporting data for analyzing the quality. RESULTS: The result showed that the timeliness of the 52 medical treatment organizations was 94.18%, the consistency was 80.84%, the completeness was 88.47%, and the misreport was 13.73%. The reporting quality of the second level hospitals was higher than that of the first level hospitals, township health centers and the third level hospitals. The reporting quality of urban hospitals was higher than that of the suburb hospitals. The reporting quality of outpatient and inpatient departments was higher than that of the laboratory. The laboratory was the primary part of underreporting. CONCLUSION: Strengthening guidance, training and paying attention to each weak portion would certainly ameliorate the quality of infectious diseases reporting via network.

[Impact of ageing and related factors on death rate of diabetes mellitus in Beijing].

OBJECTIVE: To analyze the ageing and related risk factors affecting the death rate of diabetes mellitus in Beijing, and make a correct assessment of risk factors in changing the death rate of diabetes mellitus. METHOD: The changes of death rate on diabetes mellitus in the past 10 years, from 1991 to 2000 were analyzed and calculated as to making clear what is the effects resulting from the ageing and the risk factors. RESULTS: The death rate of diabetes mellitus was increased to 117.55%, from 1991 to 2000, in which 53.28% were attributing to the ageing and 46.72% to the risk factors. CONCLUSION: The effects of ageing and risk factors on death rate of diabetes mellitus should be different and the ageing should be a factor more important than the other risk factors.