Objective： We analyzed the proportion of cancer-caused hospitalization expenses in total hospitalization expenses from national authoritative data and explored influencing factors of the proportion so as to provide e...Objective： We analyzed the proportion of cancer-caused hospitalization expenses in total hospitalization expenses from national authoritative data and explored influencing factors of the proportion so as to provide effective data information for more rational utilization of health resources.Methods： Two-level lineal regression model was used to explore influencing factors of ratios of the cancer inpatient expenditure over the total inpatient expenditure of hospitals in China in 2015. A total of 40.76 million inpatient medical records were used to generate the outcome variables, while the explanatory variables were from hospital information database and China Health and Family Planning Statistical Yearbook and literatures.Results： Inpatient expenditure pattern for cancer（IEPC） varied largely across provinces, ranging from 3.03% to19.61%. The major sources of variability were from the differences of hospital level and number of beds. There was homogeneity within a province, while heterogeneity between the provinces. Rising one level of the hospital led to the increase of 0.475 natural logarithm units of IEPC averagely. The number of beds increasing 1,000 each made the natural logarithm of IEPC increase one unit averagely.Conclusions： Our study showed that a considerable proportion of IEPC variation could be explained by the differences of hospital level and number of beds. It implied that it is possible to estimate disease-specific ratio of inpatient expense taking into account key influencing factors in China. Furthermore, this study is an input to economic and financial analyses and provides evidence for future study on the national economic burden of cancer.展开更多
Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions...Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions. Design: The 2010 Minnesota Adult Tobacco Survey (MATS) is a random digit dial telephone survey with 7057 Minnesota adults. Both landline and mobile telephone samples were included. These samples were combined and weighted to represent the population of adults in Minnesota. Results: Among adult Minnesotans, 16.1% were current smokers, 80.9% reported seeing a health care provider in the past 12 months and 80.2% of those adults were asked if they smoke. Among smokers who saw any provider in the past 12 months, 94.4% reported they were asked about smoking and 71.8% were advised not to smoke. In contrast, 43.9% of smokers received referrals from a health care provider and among those, 37.5% were recommended medications and 24.8% were referred to a quit smoking program. Conclusion: Given the large body of evidence supporting cessation interventions by health care providers, the increase in use of electronic medical records and the availability and success of evidence-based cessation programs, efforts to improve rates of identifying and treating each tobacco user are needed. Further research is needed to explore how cessation intervention responsibilities can be shared among the clinical team and integrated into ongoing clinical care.展开更多
In his 1987 classic book on multiple imputation (MI), Rubin used the fraction of missing information, γ, to define the relative efficiency (RE) of MI as RE = (1 + γ/m)?1/2, where m is the number of imputations, lead...In his 1987 classic book on multiple imputation (MI), Rubin used the fraction of missing information, γ, to define the relative efficiency (RE) of MI as RE = (1 + γ/m)?1/2, where m is the number of imputations, leading to the conclusion that a small m (≤5) would be sufficient for MI. However, evidence has been accumulating that many more imputations are needed. Why would the apparently sufficient m deduced from the RE be actually too small? The answer may lie with γ. In this research, γ was determined at the fractions of missing data (δ) of 4%, 10%, 20%, and 29% using the 2012 Physician Workflow Mail Survey of the National Ambulatory Medical Care Survey (NAMCS). The γ values were strikingly small, ranging in the order of 10?6 to 0.01. As δ increased, γ usually increased but sometimes decreased. How the data were analysed had the dominating effects on γ, overshadowing the effect of δ. The results suggest that it is impossible to predict γ using δ and that it may not be appropriate to use the γ-based RE to determine sufficient m.展开更多
Objective: A solid understanding of levels and trends of spending on cancer is important to evaluate whether our healthcare resources were wisely spent and to prioritize future resources for cancer treatment and preve...Objective: A solid understanding of levels and trends of spending on cancer is important to evaluate whether our healthcare resources were wisely spent and to prioritize future resources for cancer treatment and prevention. However, studies on economic burden of cancers in China are scant and the results are inconsistent. Methods: The Chinese hospital information database and nearly 350 million inpatient medical record data were used. As the ratios of cancer inpatient payments to total inpatient payments were mainly influenced by the grades and sites of hospitals, the estimates of payments of cancer inpatients in this study were stratified by hospital grades and provinces. Only the payments of cancer inpatients happened in grade 2, grade 3 and specialized cancer hospitals were included in the analyses. The total medical payments of cancers in China were estimated based on the ratios of outpatient payments to inpatient payments in specialized cancer hospitals. Results: From 2011 to 2015, the payments of cancer inpatients in China have increased by 84.1% and the total inpatient payments reached 177.1 billion RMB in 2015, accounting for 4.3% of the total health expenditure in China. Based on the ratio of outpatient payments to inpatient payments, the total payments on cancer treatments in China were estimated to be 221.4 billion RMB in 2015. Among different cancer types, the highest payments were the treatment of trachea, bronchus and lung cancer. The major cancer inpatient payments (67.1% in 2015) spent in grade 3 general hospitals and this ratio increased continually from 2011 to 2015. The expenditure of cancer treatments also varies by region with the major expenditure in the eastern region of China. Conclusions: This study estimated the total payments of cancer treatments in China and analyzed how the money was spent on cancer treatments in the recent 5 years, which would provide information for decision makings on the allocation of resources to service provisioning, prevention strategies, research funding, and assessing whether the economic burden of cancer is affordable to the governments.展开更多
Objective:To describe the contemporary trends in total,inpatient,and outpatient expenditure on major subtypes of cancer in different classifications of hospitals in China's Mainland.Methods:Home page of Inpatient ...Objective:To describe the contemporary trends in total,inpatient,and outpatient expenditure on major subtypes of cancer in different classifications of hospitals in China's Mainland.Methods:Home page of Inpatient Medical Records(HIMRs)and Hospital Annual Reports(HARs)were used to estimate hospital care expenditure on cancer.Inpatient payments and their share of cancer were calculated with the top-down method.Kriging spatial interpolation methods were used at the county level and summed at the province level.Outpatient expenditure was estimated with inpatient expenditure and the ratios of outpatient to inpatient payments in specialized cancer hospitals,stratified by province.Total expenditure on cancer was the sum of both payments.Log-linear regression was applied to estimate annual percentage change(APC)of expenditure.Results:Total expenses for cancer of Chinese residents reached up to 304.84 billion Chinese Yuan(CNY)in2017,accounting for 5.8%of the total health expenses(THE).After adjusting for consumer price index(CPI),medical expenses for cancer have increased from 63.30 billion CNY in 2008 to 249.56 billion CNY in 2017[APC:15.2%,95%confidence interval(95%CI):13.4%-17.0%].The APC was slightly higher than THE around 2013,while was lower after 2013.During 2008-2017,the ratio of inpatient to outpatient costs for cancer decreased from4.3:1 to 3.8:1.The inpatient payments for cancer mainly happened in grade 3 general hospitals,East China,and among lung,colorectal,and stomach cancer;while the fastest increase was found in West China,and among thyroid,prostate,and colorectal cancer.Conclusions:During 2008-2017,the rapid growth trend of medical expenses for cancer has been effectively controlled with the continuous deepening of medical reform and improvements of residents’health care.More attention should be paid to potential increases of medical costs caused by technological progress and demand release.Socialized and multi-channel insurance financing modes should be explored in the future.展开更多
Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further contro...Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.展开更多
How many imputations are sufficient in multiple imputations? The answer given by different researchers varies from as few as 2 - 3 to as many as hundreds. Perhaps no single number of imputations would fit all situatio...How many imputations are sufficient in multiple imputations? The answer given by different researchers varies from as few as 2 - 3 to as many as hundreds. Perhaps no single number of imputations would fit all situations. In this study, η, the minimally sufficient number of imputations, was determined based on the relationship between m, the number of imputations, and ω, the standard error of imputation variances using the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Workflow mail survey. Five variables of various value ranges, variances, and missing data percentages were tested. For all variables tested, ω decreased as m increased. The m value above which the cost of further increase in m would outweigh the benefit of reducing ω was recognized as the η. This method has a potential to be used by anyone to determine η that fits his or her own data situation.展开更多
Background -High blood pressure can be controlled through existing antihypertensive drug therapy. This study examined trends in prescribed antihypertensive medication use among US adults with hypertension and compared...Background -High blood pressure can be controlled through existing antihypertensive drug therapy. This study examined trends in prescribed antihypertensive medication use among US adults with hypertension and compared drug utilization patterns with recommendations of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Methods and Results -Persons aged ≥18 years from the National Health and Nutrition Examination Surveys were identified as hypertensive on the basis of either a blood pressure ≥140/90mm Hg or self-reported current treatment for hypertension with a prescription medication. In 1999-2002, 62.9%of US hypertensive adults took a prescription antihypertensive medication compared with 57.3%during 1988-1994(P< 0.01). Men had the greatest increase in antihypertensive medication use(47.5%, 1988-1994 versus 57.9%, 1999-2002[P< 0.001]). In both surveys, antihypertensive medication use increased with age, was lower among men than among women, and was lower among Mexican Americans than among non-Hispanic whites and blacks. Multiple antihypertensive drug use increased from 29.1%to 35.8%(P< 0.001). Polytherapy with a calcium channel blocker, β-blocker, or angiotensin-converting enzyme inhibitor significantly increased by 30%, 42%, and 68%, respectively, whereas monotherapy with a diuretic or β-blocker significantly decreased. For hypertensives with diabetes, congestive heart failure, or a prior heart attack, the utilization patterns closely followed the Sixth Joint National Committee guideline recommendations. Conclusions -Antihypertensive medication use and multiple antihypertensive medication use among US hypertensive adults increased over the past 10 years, but disparities by sociodemographic factors continue to exist.展开更多
Objective: There is a lack of data focusing on non-communicable disease (NCD) mortality in the Chinese elderly population over the past decade.Methods: Using mortality data from the Chinese Health Statistics, we explo...Objective: There is a lack of data focusing on non-communicable disease (NCD) mortality in the Chinese elderly population over the past decade.Methods: Using mortality data from the Chinese Health Statistics, we explored the crude and age-standardized mortality trend of three major NCDs in the Chinese population ≥65 years of age from 2002 to 2010, namely, malignant neoplasms, heart diseases, and cerebrovascular diseases.Subpopulations characterized as rural and urban residence, and by gender and age were examined separately.Results: Mortality increased with age and was higher among males than among females across the three NCDs, with the gender difference being most remarkable for malignant neoplasms and least for heart diseases mortality.Condition-specific crude mortalities increased between 2002 and 2010, overall and in all the pre-specified subpopulations.After age-standardization, rising trends were observed for people ≥65 years old, and condition-specific mortalities generally increased in rural regions and decreased in urban regions, especially for cerebrovascular diseases.Conclusions: There were increasing trends for mortality due to malignant neoplasms, heart diseases, and cerebrovascular diseases in China between 2002 and 2010, which were largely driven by the population aging.Disparities existed by rural and urban residence, gender, and age.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
Introduction:Disability-free life expectancy(DFLE)is a key metric of healthy aging.While prior studies have explored its trends and provincial-level patterns,sub-provincial variations and urban-rural disparities in Ch...Introduction:Disability-free life expectancy(DFLE)is a key metric of healthy aging.While prior studies have explored its trends and provincial-level patterns,sub-provincial variations and urban-rural disparities in China are underexplored.Methods:DFLE across prefectures was estimated using the Sullivan method,based on mortality data from the death registration system and disability data from the National Health Service Survey.A geodetector was used to assess the explanatory power of the socioeconomic,healthcare,environmental,and demographic factors.Results:DFLE increased in all regions between 2018 and 2023,with a narrowing urban-rural gap.The largest gains occurred in the western region,but urban–rural inequality showed the least improvement.DFLE exhibited notable stratified spatial heterogeneity,predominantly driven by socioeconomic factors,whose influence weakened with advancing age,whereas environmental and demographic factors became more prominent.All the factors had stronger explanatory power in rural areas.Conclusion:Although DFLE improved nationwide,inequalities persisted.Targeted public health strategies are needed to reduce disparities,with priority placed on healthcare access,social security,and climateadaptive infrastructure in rural areas,particularly in western China.展开更多
Introduction:The Global Activity Limitation Indicator(GALI)offers a simpler and more efficient approach to measuring disability compared to traditional instruments.While GALI’s reliability has been validated across d...Introduction:The Global Activity Limitation Indicator(GALI)offers a simpler and more efficient approach to measuring disability compared to traditional instruments.While GALI’s reliability has been validated across different regions,its effectiveness is influenced by cultural differences.This study aims to assess GALI’s applicability in China and examine the relationships between GALI and mortality rates,as well as health human resources.Methods:We analyzed data from the Resident Health and Health Service Monitoring survey,a nationally representative cross-sectional survey conducted annually from 2019−2022.Multivariate and multinomial logistic regression models were employed to estimate odds ratios and activity limitation probabilities.Mixed effect models were used to explore county-level associations.Results:GALI demonstrated high response rates and reliability throughout the survey period.Significant associations were observed between GALI and traditional disability instruments,as well as disease prevalence.At the county level,GALI showed positive associations with mortality rates and negative associations with the number of physicians per thousand residents.Conclusions:GALI represents a reliable measure of disability for the Chinese mainland population and could serve as a potential predictor for cardiovascular diseases,respiratory system diseases,and unintentional injuries.Our findings suggest that increasing the number of physicians per thousand residents may be associated with reduced activity limitation,though additional research is needed to validate this relationship.展开更多
Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe t...Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy(LE)increase in China.Methods::All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission.We estimated CVD mortality rates by allocating age-and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system.The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga’s method to quantitate age-and cause-specific contributions to LE gains.Results::During 2013 to 2018,the age-standardized mortality rate of CVD decreased from 289.69(95%confidence interval[CI]:289.03,290.35)/100,000 to 272.37(95%CI:271.81,272.94)/100,000,along with a decline in probability of CVD premature deaths from 9.05%(95%CI:9.02%,9.09%)to 8.13%(95%CI:8.10%,8.16%).The gap in CVD mortality across sexes expanded with more remarkable declines in females,especially for those aged 15 to 64 years.Among major subtypes,the probability of premature deaths from hemorrhage stroke declined fastest,while improvements of ischemic stroke and ischemic heart disease were limited,and there was an increase in stroke sequelae.LE in China reached 77.04(95%CI:76.96,77.12)years in 2018 with an increase of 1.38 years from 2013.Of the total LE gains,21.15%(0.29 years)were attributed to reductions of CVD mortality in the overall population,mostly driven by those aged>65 years.Conclusions::The general process in reducing CVD mortality has contributed to longevity improvements in China.More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae,especially for the elderly.Working-age males also deserve additional attention due to inadequate improvements.展开更多
Summary What is already known about this topic?The impacts of population aging have appeared in China,leading to a marked shift in the major contributors to life expectancy.Longevity improvements are now mainly promot...Summary What is already known about this topic?The impacts of population aging have appeared in China,leading to a marked shift in the major contributors to life expectancy.Longevity improvements are now mainly promoted by reductions in mortality rates of the aged.What is added by this report?This study systematically evaluates both changes in mortality rates of major chronic diseases among populations aged over 60 years as well as their contributions to life expectancy increases in China,from 2005 to 2020.What are the implications for public health practice?The results of this study demonstrate that more attention should be paid to health conditions of the elderly,especially for the prevention and control of major chronic diseases.展开更多
To the Editor:Data linkage is a method of identifying and combining information derived from various sources that actually belongs to the same individual or event.[1]In recent years,data linkage has become an increasi...To the Editor:Data linkage is a method of identifying and combining information derived from various sources that actually belongs to the same individual or event.[1]In recent years,data linkage has become an increasingly common practice in many countries.The socioeconomic and health benefits of data linkage in the healthcare field can be clearly demonstrated.From the perspective of scientific research,the combination of multidimensional health-related data at the individual level(e.g.,risk factor data,clinical diagnosis and treatment data,community management and follow-up data,disease surveillance data,birth,and vital statistics)and public records(e.g.,environmental monitoring data,motor vehicle crash data,criminal data)can create scientific inspiration in multiple disciplines and spur innovation.From the perspective of health management.展开更多
基金supported by National Natural Science Foundation of China (No. 71403189)
文摘Objective： We analyzed the proportion of cancer-caused hospitalization expenses in total hospitalization expenses from national authoritative data and explored influencing factors of the proportion so as to provide effective data information for more rational utilization of health resources.Methods： Two-level lineal regression model was used to explore influencing factors of ratios of the cancer inpatient expenditure over the total inpatient expenditure of hospitals in China in 2015. A total of 40.76 million inpatient medical records were used to generate the outcome variables, while the explanatory variables were from hospital information database and China Health and Family Planning Statistical Yearbook and literatures.Results： Inpatient expenditure pattern for cancer（IEPC） varied largely across provinces, ranging from 3.03% to19.61%. The major sources of variability were from the differences of hospital level and number of beds. There was homogeneity within a province, while heterogeneity between the provinces. Rising one level of the hospital led to the increase of 0.475 natural logarithm units of IEPC averagely. The number of beds increasing 1,000 each made the natural logarithm of IEPC increase one unit averagely.Conclusions： Our study showed that a considerable proportion of IEPC variation could be explained by the differences of hospital level and number of beds. It implied that it is possible to estimate disease-specific ratio of inpatient expense taking into account key influencing factors in China. Furthermore, this study is an input to economic and financial analyses and provides evidence for future study on the national economic burden of cancer.
文摘Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions. Design: The 2010 Minnesota Adult Tobacco Survey (MATS) is a random digit dial telephone survey with 7057 Minnesota adults. Both landline and mobile telephone samples were included. These samples were combined and weighted to represent the population of adults in Minnesota. Results: Among adult Minnesotans, 16.1% were current smokers, 80.9% reported seeing a health care provider in the past 12 months and 80.2% of those adults were asked if they smoke. Among smokers who saw any provider in the past 12 months, 94.4% reported they were asked about smoking and 71.8% were advised not to smoke. In contrast, 43.9% of smokers received referrals from a health care provider and among those, 37.5% were recommended medications and 24.8% were referred to a quit smoking program. Conclusion: Given the large body of evidence supporting cessation interventions by health care providers, the increase in use of electronic medical records and the availability and success of evidence-based cessation programs, efforts to improve rates of identifying and treating each tobacco user are needed. Further research is needed to explore how cessation intervention responsibilities can be shared among the clinical team and integrated into ongoing clinical care.
文摘In his 1987 classic book on multiple imputation (MI), Rubin used the fraction of missing information, γ, to define the relative efficiency (RE) of MI as RE = (1 + γ/m)?1/2, where m is the number of imputations, leading to the conclusion that a small m (≤5) would be sufficient for MI. However, evidence has been accumulating that many more imputations are needed. Why would the apparently sufficient m deduced from the RE be actually too small? The answer may lie with γ. In this research, γ was determined at the fractions of missing data (δ) of 4%, 10%, 20%, and 29% using the 2012 Physician Workflow Mail Survey of the National Ambulatory Medical Care Survey (NAMCS). The γ values were strikingly small, ranging in the order of 10?6 to 0.01. As δ increased, γ usually increased but sometimes decreased. How the data were analysed had the dominating effects on γ, overshadowing the effect of δ. The results suggest that it is impossible to predict γ using δ and that it may not be appropriate to use the γ-based RE to determine sufficient m.
基金supported by National Natural Science Foundation of China (No.71403189)
文摘Objective: A solid understanding of levels and trends of spending on cancer is important to evaluate whether our healthcare resources were wisely spent and to prioritize future resources for cancer treatment and prevention. However, studies on economic burden of cancers in China are scant and the results are inconsistent. Methods: The Chinese hospital information database and nearly 350 million inpatient medical record data were used. As the ratios of cancer inpatient payments to total inpatient payments were mainly influenced by the grades and sites of hospitals, the estimates of payments of cancer inpatients in this study were stratified by hospital grades and provinces. Only the payments of cancer inpatients happened in grade 2, grade 3 and specialized cancer hospitals were included in the analyses. The total medical payments of cancers in China were estimated based on the ratios of outpatient payments to inpatient payments in specialized cancer hospitals. Results: From 2011 to 2015, the payments of cancer inpatients in China have increased by 84.1% and the total inpatient payments reached 177.1 billion RMB in 2015, accounting for 4.3% of the total health expenditure in China. Based on the ratio of outpatient payments to inpatient payments, the total payments on cancer treatments in China were estimated to be 221.4 billion RMB in 2015. Among different cancer types, the highest payments were the treatment of trachea, bronchus and lung cancer. The major cancer inpatient payments (67.1% in 2015) spent in grade 3 general hospitals and this ratio increased continually from 2011 to 2015. The expenditure of cancer treatments also varies by region with the major expenditure in the eastern region of China. Conclusions: This study estimated the total payments of cancer treatments in China and analyzed how the money was spent on cancer treatments in the recent 5 years, which would provide information for decision makings on the allocation of resources to service provisioning, prevention strategies, research funding, and assessing whether the economic burden of cancer is affordable to the governments.
基金supported by the National Key Research and Development Program of China(No.2018YFC 1311704)。
文摘Objective:To describe the contemporary trends in total,inpatient,and outpatient expenditure on major subtypes of cancer in different classifications of hospitals in China's Mainland.Methods:Home page of Inpatient Medical Records(HIMRs)and Hospital Annual Reports(HARs)were used to estimate hospital care expenditure on cancer.Inpatient payments and their share of cancer were calculated with the top-down method.Kriging spatial interpolation methods were used at the county level and summed at the province level.Outpatient expenditure was estimated with inpatient expenditure and the ratios of outpatient to inpatient payments in specialized cancer hospitals,stratified by province.Total expenditure on cancer was the sum of both payments.Log-linear regression was applied to estimate annual percentage change(APC)of expenditure.Results:Total expenses for cancer of Chinese residents reached up to 304.84 billion Chinese Yuan(CNY)in2017,accounting for 5.8%of the total health expenses(THE).After adjusting for consumer price index(CPI),medical expenses for cancer have increased from 63.30 billion CNY in 2008 to 249.56 billion CNY in 2017[APC:15.2%,95%confidence interval(95%CI):13.4%-17.0%].The APC was slightly higher than THE around 2013,while was lower after 2013.During 2008-2017,the ratio of inpatient to outpatient costs for cancer decreased from4.3:1 to 3.8:1.The inpatient payments for cancer mainly happened in grade 3 general hospitals,East China,and among lung,colorectal,and stomach cancer;while the fastest increase was found in West China,and among thyroid,prostate,and colorectal cancer.Conclusions:During 2008-2017,the rapid growth trend of medical expenses for cancer has been effectively controlled with the continuous deepening of medical reform and improvements of residents’health care.More attention should be paid to potential increases of medical costs caused by technological progress and demand release.Socialized and multi-channel insurance financing modes should be explored in the future.
基金supported by National Natural Science Foundation of China (No. 71403189)
文摘Objective： An understanding of the levels and trends of medical cost is made for breast cancer patients with different medical insurance coverages in China（mainland）, in an attempt to offer a clue to further control the costs.Methods： The inpatient payments of 9,716,180 breast cancer patients spent in medical institutions of different types and grades during 2011–2015 were collected from the inpatient medical record home page（IMRHP） dataset.The data were then processed with SAS（Version 9.3; SAS Institute, Cary, NC, USA）. Indicators like means,increase（decrease） percentages were used to descriptively analyze the average hospitalization expense of each time（AHEET） and its trends of breast cancer patients with different medical insurance coverages treated in medical institutions of different types and grades.Results：In 2011–2015,the AHEET borne by breast cancer patients in China had been constantly increasing.Specifically,the self-pay inpatients had the largest increase,inpatients covered by Urban Employee Basic Medical Insurance（UEBMI）and Urban Resident Basic Medical Insurance（URBMI）were the next,and those covered by New Rural Cooperative Medical System（NRCMS）had the least increase.Breast cancer inpatient treated in public hospitals had quite greater increase and higher expenditure level than those in private hospitals.The AHEET borne by the inpatients in Grade 3 hospitals had greater increase and higher cost than those in Grade 2 hospitals.Conclusions：The inpatient payments of breast cancer patients will be wisely controlled by reducing the number of self-pay inpatients,taking advantage of restriction mechanism of the medical insurances,and promoting healthy competition between private hospitals and public hospitals.The economic burden imposed on the society by breast cancer can be relieved through further control of inpatient payments of UEBMI-and URBMI-covered breast cancer patients and of Grade 3 hospitals.
文摘How many imputations are sufficient in multiple imputations? The answer given by different researchers varies from as few as 2 - 3 to as many as hundreds. Perhaps no single number of imputations would fit all situations. In this study, η, the minimally sufficient number of imputations, was determined based on the relationship between m, the number of imputations, and ω, the standard error of imputation variances using the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Workflow mail survey. Five variables of various value ranges, variances, and missing data percentages were tested. For all variables tested, ω decreased as m increased. The m value above which the cost of further increase in m would outweigh the benefit of reducing ω was recognized as the η. This method has a potential to be used by anyone to determine η that fits his or her own data situation.
文摘Background -High blood pressure can be controlled through existing antihypertensive drug therapy. This study examined trends in prescribed antihypertensive medication use among US adults with hypertension and compared drug utilization patterns with recommendations of the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Methods and Results -Persons aged ≥18 years from the National Health and Nutrition Examination Surveys were identified as hypertensive on the basis of either a blood pressure ≥140/90mm Hg or self-reported current treatment for hypertension with a prescription medication. In 1999-2002, 62.9%of US hypertensive adults took a prescription antihypertensive medication compared with 57.3%during 1988-1994(P< 0.01). Men had the greatest increase in antihypertensive medication use(47.5%, 1988-1994 versus 57.9%, 1999-2002[P< 0.001]). In both surveys, antihypertensive medication use increased with age, was lower among men than among women, and was lower among Mexican Americans than among non-Hispanic whites and blacks. Multiple antihypertensive drug use increased from 29.1%to 35.8%(P< 0.001). Polytherapy with a calcium channel blocker, β-blocker, or angiotensin-converting enzyme inhibitor significantly increased by 30%, 42%, and 68%, respectively, whereas monotherapy with a diuretic or β-blocker significantly decreased. For hypertensives with diabetes, congestive heart failure, or a prior heart attack, the utilization patterns closely followed the Sixth Joint National Committee guideline recommendations. Conclusions -Antihypertensive medication use and multiple antihypertensive medication use among US hypertensive adults increased over the past 10 years, but disparities by sociodemographic factors continue to exist.
文摘Objective: There is a lack of data focusing on non-communicable disease (NCD) mortality in the Chinese elderly population over the past decade.Methods: Using mortality data from the Chinese Health Statistics, we explored the crude and age-standardized mortality trend of three major NCDs in the Chinese population ≥65 years of age from 2002 to 2010, namely, malignant neoplasms, heart diseases, and cerebrovascular diseases.Subpopulations characterized as rural and urban residence, and by gender and age were examined separately.Results: Mortality increased with age and was higher among males than among females across the three NCDs, with the gender difference being most remarkable for malignant neoplasms and least for heart diseases mortality.Condition-specific crude mortalities increased between 2002 and 2010, overall and in all the pre-specified subpopulations.After age-standardization, rising trends were observed for people ≥65 years old, and condition-specific mortalities generally increased in rural regions and decreased in urban regions, especially for cerebrovascular diseases.Conclusions: There were increasing trends for mortality due to malignant neoplasms, heart diseases, and cerebrovascular diseases in China between 2002 and 2010, which were largely driven by the population aging.Disparities existed by rural and urban residence, gender, and age.Copyright 2015, Chinese Medical Association Production.Production and hosting by Elsevier B.V.on behalf of KeAi Communications Co., Ltd.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
基金Supported by the National Key Research and Development Program of China(2022YFC3600800)the National Office for Philosophy and Social Sciences(21&ZD186).
文摘Introduction:Disability-free life expectancy(DFLE)is a key metric of healthy aging.While prior studies have explored its trends and provincial-level patterns,sub-provincial variations and urban-rural disparities in China are underexplored.Methods:DFLE across prefectures was estimated using the Sullivan method,based on mortality data from the death registration system and disability data from the National Health Service Survey.A geodetector was used to assess the explanatory power of the socioeconomic,healthcare,environmental,and demographic factors.Results:DFLE increased in all regions between 2018 and 2023,with a narrowing urban-rural gap.The largest gains occurred in the western region,but urban–rural inequality showed the least improvement.DFLE exhibited notable stratified spatial heterogeneity,predominantly driven by socioeconomic factors,whose influence weakened with advancing age,whereas environmental and demographic factors became more prominent.All the factors had stronger explanatory power in rural areas.Conclusion:Although DFLE improved nationwide,inequalities persisted.Targeted public health strategies are needed to reduce disparities,with priority placed on healthcare access,social security,and climateadaptive infrastructure in rural areas,particularly in western China.
基金The National Key Research and Development Plan of China(2022YFC3600800)The National Office for Philosophy and Social Sciences(21&ZD186).
文摘Introduction:The Global Activity Limitation Indicator(GALI)offers a simpler and more efficient approach to measuring disability compared to traditional instruments.While GALI’s reliability has been validated across different regions,its effectiveness is influenced by cultural differences.This study aims to assess GALI’s applicability in China and examine the relationships between GALI and mortality rates,as well as health human resources.Methods:We analyzed data from the Resident Health and Health Service Monitoring survey,a nationally representative cross-sectional survey conducted annually from 2019−2022.Multivariate and multinomial logistic regression models were employed to estimate odds ratios and activity limitation probabilities.Mixed effect models were used to explore county-level associations.Results:GALI demonstrated high response rates and reliability throughout the survey period.Significant associations were observed between GALI and traditional disability instruments,as well as disease prevalence.At the county level,GALI showed positive associations with mortality rates and negative associations with the number of physicians per thousand residents.Conclusions:GALI represents a reliable measure of disability for the Chinese mainland population and could serve as a potential predictor for cardiovascular diseases,respiratory system diseases,and unintentional injuries.Our findings suggest that increasing the number of physicians per thousand residents may be associated with reduced activity limitation,though additional research is needed to validate this relationship.
基金This study was supported by grants from the Chinese Academyof MedicalSciences(CAMS)Innovation Fund for Medical Sciences(No.2021-I2M-1-010,No.2017-I2M-1-004)the National Natural Science Foundation of China(No.12126602,No.82030102)the National Key R&D Program of China(No.2017YFC0211700).
文摘Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy(LE)increase in China.Methods::All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission.We estimated CVD mortality rates by allocating age-and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system.The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga’s method to quantitate age-and cause-specific contributions to LE gains.Results::During 2013 to 2018,the age-standardized mortality rate of CVD decreased from 289.69(95%confidence interval[CI]:289.03,290.35)/100,000 to 272.37(95%CI:271.81,272.94)/100,000,along with a decline in probability of CVD premature deaths from 9.05%(95%CI:9.02%,9.09%)to 8.13%(95%CI:8.10%,8.16%).The gap in CVD mortality across sexes expanded with more remarkable declines in females,especially for those aged 15 to 64 years.Among major subtypes,the probability of premature deaths from hemorrhage stroke declined fastest,while improvements of ischemic stroke and ischemic heart disease were limited,and there was an increase in stroke sequelae.LE in China reached 77.04(95%CI:76.96,77.12)years in 2018 with an increase of 1.38 years from 2013.Of the total LE gains,21.15%(0.29 years)were attributed to reductions of CVD mortality in the overall population,mostly driven by those aged>65 years.Conclusions::The general process in reducing CVD mortality has contributed to longevity improvements in China.More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae,especially for the elderly.Working-age males also deserve additional attention due to inadequate improvements.
基金National Office for Philosophy and Social Sciences(21&ZD186).
文摘Summary What is already known about this topic?The impacts of population aging have appeared in China,leading to a marked shift in the major contributors to life expectancy.Longevity improvements are now mainly promoted by reductions in mortality rates of the aged.What is added by this report?This study systematically evaluates both changes in mortality rates of major chronic diseases among populations aged over 60 years as well as their contributions to life expectancy increases in China,from 2005 to 2020.What are the implications for public health practice?The results of this study demonstrate that more attention should be paid to health conditions of the elderly,especially for the prevention and control of major chronic diseases.
基金supported by grants from the National Key Research and Development Program of China(Nos.2021YFF1201101,2018YFC1311704,and 2018YFC 1311706).
文摘To the Editor:Data linkage is a method of identifying and combining information derived from various sources that actually belongs to the same individual or event.[1]In recent years,data linkage has become an increasingly common practice in many countries.The socioeconomic and health benefits of data linkage in the healthcare field can be clearly demonstrated.From the perspective of scientific research,the combination of multidimensional health-related data at the individual level(e.g.,risk factor data,clinical diagnosis and treatment data,community management and follow-up data,disease surveillance data,birth,and vital statistics)and public records(e.g.,environmental monitoring data,motor vehicle crash data,criminal data)can create scientific inspiration in multiple disciplines and spur innovation.From the perspective of health management.
