Unmet needs as indicator of improving chronic care delivery system in China

Burden, risk factors, and projections of ischemic heart disease in China (1990-2021): findings from the 2021 GBD study

Background

Ischemic heart disease (IHD) remains a major public health challenge in China. This study aimed to comprehensively analyze the burden of IHD, its risk factors, and future trends from 1990 to 2021 using the Global Burden of Disease database.

Methods

We assessed IHD trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) stratified by age (greater than 15 years) and gender. Age-standardized rates, average annual percentage changes, and joinpoint regression analyses were used to evaluate temporal trends. Decomposition and frontier analyses were conducted to identify key contributors to the IHD burden, while future projections were generated for the next 15 years.

Results

In 2021, the number of IHD incident cases, prevalent cases, deaths, and DALYs in China were 3.17, 3.25, 3.57, and 2.62 times higher than those in 1990, respectively. Age-standardized mortality rates and age-standardized DALYs rates demonstrated an initial increase, followed by a gradual decline. Males showed higher IHD burden during middle age, while elderly females surpassed males in the later years. Aging, high systolic blood pressure, ambient particulate matter pollution, elevated low-density lipoprotein cholesterol, and smoking were the primary drivers of IHD burden. Future projections suggest a declining incidence and prevalence among males but increasing trends in females, with DALYs expected to rise significantly in the female population.

Conclusions

The burden of IHD in China has evolved significantly over the past three decades, driven by demographic and environmental factors. While prevalence and incidence have risen, mortality and DALYs have shown a recent decline, reflecting shifts in disease patterns. Age and gender disparities are evident, with middle-aged males and elderly females disproportionately affected. Key contributors, such as high blood pressure and pollution, highlight the need for targeted interventions. Gender-specific public health strategies, alongside improved environmental and health policies, are essential to mitigating the future burden of IHD in China.

The care cascade of chronic obstructive pulmonary disease in China: a cross-sectional study of individual-level data at enrolment into the national 'Happy Breathing' Programme

Background

Understanding the chronic obstructive pulmonary disease (COPD) care cascade is crucial for identifying where and when to intervene to improve COPD outcomes. We aimed to determine the proportion of patients with COPD seeking care in China's health system who are lost at each stage of the COPD care cascade and how the patterns of loss vary across geographical regions and population groups.

Methods

From November 3, 2018, to April 22, 2021, we used individual-level patient data from the national Chinese 'Happy Breathing' Programme, which aims to identify patients with COPD and provide appropriate care. COPD was defined as a post-bronchodilator ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) <0.70. We calculated the proportions of individuals who, at enrolment into the 'Happy Breathing' Programme, (i) had ever undergone a pulmonary function test, (ii) had been diagnosed with COPD in the past, (iii) were currently on treatment for COPD, and (iv) had achieved control of their COPD. We examined the association between reaching each stage of the care cascade and individual patient characteristics as well as regional-level economic development and available resources in the health system using multilevel regression.

Findings

Among the 29,201 patients with COPD in the 'Happy Breathing' Programme, 41.0% (95% confidence interval [CI]: 40.4-41.6%) had ever been tested for COPD, 17.6% (95% CI: 17.1-18.0%) had previously been diagnosed with COPD, 8.5% (95% CI: 8.2-8.8%) were currently on treatment for COPD, 4.6% (95% CI: 4.3-4.8%) of patients had mild or no exacerbations in the prior year, and 3.9% (95% CI: 3.7-4.2%) of patients had suffered no exacerbations in the prior year. On average, patients living in the cities of Beijing, Wuhan, and Yinchuan had progressed further along the COPD care cascade than patients living in Daqing and Luoyang. Using multilevel regression, we found that young age, rural residence, and low regional per-capita GDP were significantly associated with larger losses at each stage of the COPD care cascade.

Interpretation

Substantial proportions of patients with COPD are lost at each stage of the COPD care cascade in the Chinese health system. The largest losses occur during the initial stages of the cascade, when diagnosis first occurs. New policies and interventions are required to boost COPD care, especially screening and diagnosis, in the Chinese health system to reduce this large disease burden.

Funding

This work was supported by Major Programme of National Natural Science Foundation of China (82090011), CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-049), and Horizon Europe (HORIZON-MSCA-2021-SE-01; project number 101086139-PoPMeD-SuSDeV). TB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt professorship award.

Public preferences for online medical consultations in China: a discrete choice experiment

Background

Online medical consultation (OMC) is significant to promote the utilization and accessibility of healthcare resources and save time on consultation. However, the usage and public acceptance rates of it are still low in China. Meanwhile, few studies have focused on consumers' demand of OMC services. This study aims to identify attributes that influence users' preference for OMC services, quantify the value of these characteristics, and compare their relative importance.

Methods

A nationwide discrete choice experiment was conducted to survey Chinese residents' preference choices for six attributes of OMC services. Conditional logit model and mixed logit model were used to analyze respondents' preference. Willingness to pay and heterogeneity were estimated by the mixed logit model.

Results

A total of 856 respondents completed the study, and 668 questionnaires passed the consistency test. All of 6 attributes in the study were statistically significant except for "Doctor's professional title - Associate Senior." When choosing OMC services, respondents preferred to spend as little time and money as possible on a large online medical platform to consult a high-rated physician with a senior title from a well-known Grade-A tertiary hospital. Besides, respondents valued doctor's evaluation score most and were willing to pay ¥107 to obtain the services of higher-scored doctors.

Conclusion

The study measured Chinese residents' preferences for six attributes of OMC and showed the heterogeneity of attributes among subgroups. Our findings suggested that OMC services providers should reduce the customers' waiting time, improve the quality of services and enhance professional skills to meet the customers' requirements. More research on preferences for OMC needs to be conducted in China, especially for key populations such as patients with chronic diseases.

Health education in the management of chronic diseases among the elderly in the community with the assistance of a Mask R-CNN model

OBJECTIVE

To analyze the role of health education in the management of chronic diseases in older people in the community and the countermeasures.

METHODS

After establishing a community health management model for chronic diseases of the elderly based on references, a prospective study was conducted on 120 elderly patients with chronic diseases registered in Xinyang Zhongxing Community Health Service Center, Xixiangtang District, Nanning City from January 2019 to June 2020. The lottery method was used to divide all patients into observation and control groups. Patients in the control group received conventional chronic disease health management, while the observation group received an additional community-based chronic disease health education model for the elderly on the basis of care given to the control group. The change in chronic disease prevention knowledge mastering, medical compliance behavior score, anxiety and depression score, and quality of life score before and after the intervention were compared.

RESULTS

After intervention, the awareness rates of patients in the observation group on the clinical manifestations, diagnostic criteria, high-risk behaviors, susceptible population and preventive measures of chronic diseases were significantly higher than that in the control group (all P<0.05), the scores of diet, exercise and lifestyle were significantly higher than those in the control group (all P<0.05), and the scores of depression and anxiety were significantly lower than those in the control group (all P<0.05). The scores of mental function, physical function and social function were significantly higher than those of control group (all P<0.05).

CONCLUSION

Health education intervention play an important role in community management of chronic diseases in elderly patients. It effectively improves patients' understanding of the disease and enhances their compliance to medical advice, while reducing patients' anxiety, depression mood and improving their quality of life.

Unmet chronic care needs and insufficient nurse staffing to achieve universal health coverage in China: Analysis of the Global Burden of Disease Study 2019

BACKGROUND

Although China has made impressive progress towards Universal Health Coverage through the health system reform plan since 2009, chronic disease prevention and control implementations are still inadequate to meet the need at large. This study aims to quantify the acute and chronic care needs in China and examine the human resources for health and financial protection for the population to achieve Universal Health Coverage.

METHODS

The data on disability-adjusted life years, years lived with disability, and years of life lost in China were disaggregated from the Global Burden of Diseases Study 2019 by age and sex based on acute care need or chronic care need. An auto-regressive integrated moving average model was deployed to predict the supply gap of physicians, nurses and midwives from 2020 to 2050. Out-of-pocket health expenditure was compared among China, Russia, Germany, the US, and Singapore to examine the current status of financial protection.

RESULTS

In 2019, conditions requiring chronic care accounted for 86.4% of all-cause, all-age disability-adjusted life years in China, while acute-care-need conditions accounted for 11.3%. Approximate 25.57% of disability-adjusted life years in communicable diseases and 94.32% in non-communicable diseases were caused by chronic care need conditions. Chronic care-need conditions accounted for more than 80% of both man and woman's disease burden. The proportion of disability-adjusted life years and years of life lost attributable to chronic care was greater than 90% in people aged 25 and up. The nurse and midwife supply will be in absolute shortage and unable to achieve effective universal health coverage effective coverage of 80% or 90% from 2020 to 2050, while the physician supply will be sufficient to maintain effective universal health coverage of 80% and reach 90% from 2036. The out-of-pocket health expenditure decreased with time but was still relatively higher than that of Germany, the US, and Singapore.

CONCLUSIONS

The present study demonstrates the chronic care needs outweigh those for acute care in China. Nurse supply and the financial protection for the poor were still inadequate to achieve Universal Health Coverage. Better workforce planning and concerted actions on chronic care prevention and control should be taken to meet the population's chronic care needs.