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Wing-Shing Fung W, Park HC, Hirakawa Y, Arruebo S, Bello AK, Caskey FJ, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ueda S, Ye F, Suzuki Y, Wang AYM. Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:97-109. [PMID: 38618501 PMCID: PMC11010612 DOI: 10.1016/j.kisu.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 04/16/2024] Open
Abstract
Globally, there remain significant disparities in the capacity and quality of kidney care, as evidenced by the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). In the ISN North and East Asia region, the chronic kidney disease (CKD) burden varied widely; Taiwan had the heaviest burden of treated kidney failure (3679 per million population [pmp]) followed by Japan and South Korea. Except in Hong Kong, hemodialysis (HD) was the main dialysis modality for all other countries in the region and was much higher than the global median prevalence. Kidney transplantation services were generally available in the region, but the prevalence was much lower than that of dialysis. Most countries had public funding for kidney replacement therapy (KRT). The median prevalence of nephrologists was 28.7 pmp, higher than that of any other ISN region, with variation across countries. Home HD was available in only 17% of the countries, whereas conservative kidney management was available in 50%. All countries had official registries for dialysis and transplantation; however, only China and Japan had CKD registries. Advocacy groups for CKD, kidney failure, and KRT were uncommon throughout the region. Overall, all countries in the region had capacity for KRT, albeit with some shortages in their kidney care workforce. These data are useful for stakeholders to address gaps in kidney care and to reduce workforce shortages through increased use of multidisciplinary teams and telemedicine, policy changes to promote prevention and treatment of kidney failure, and increased advocacy for kidney disease in the region.
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Affiliation(s)
- Winston Wing-Shing Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
| | - Yosuke Hirakawa
- Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia; Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Seiji Ueda
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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Pu X, He S, Lin X. The effect of urban-rural resident basic medical insurance on physical health of the rural older adult in China. Front Public Health 2024; 12:1319697. [PMID: 38344234 PMCID: PMC10853402 DOI: 10.3389/fpubh.2024.1319697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Urban-Rural Resident Basic Medical Insurance (URRBMI) is an important system for effectively transferring disease risks to the rural older adult. As China experiences rapid aging, maintaining the physical health of the rural older adult is key to achieving the goal of healthy aging. Methods The study explores the impact of URRBMI on physical health of the rural older adult in China using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018. Ordinary least square models were used to analyze the relationship between URRBMI and physical health of the rural older adult, and we used instrumental variable method to address the potential endogenous problem. Results We find that URRBMI greatly improves physical health of the rural older adult. The heterogeneity analysis indicates that URRBMI contributes more significantly to the rural older adult in eastern areas and the advanced rural older adult. The results also suggested that URRBMI improves physical health of the rural older adult through increasing life satisfaction and enhancing the timeliness of medical services. Recommendations This study implies that we need to further improve the participation rate, increase the actual reimbursement ratio and increase financial subsidies for URRBMI in central and western areas, and further integrate the distribution of medical resources to promote physical health of the rural older adult.
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Affiliation(s)
| | | | - Xi Lin
- School of Public Administration, Sichuan University, Chengdu, China
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Zhang L, Shi K, Wang C, Li Z. Rural-urban disparities in the unmet need for home visiting services among oldest-old in China: Changes over time and decomposition analysis. Arch Gerontol Geriatr 2023; 108:104919. [PMID: 36603358 DOI: 10.1016/j.archger.2022.104919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aims to assess trends in rural-urban disparities in the prevalence of unmet community-based home visiting services need and their contributing factors from 2005 to 2018 among oldest-old in China. METHODS The Chinese Longitudinal Healthy Longevity Survey data of oldest-old collected with a targeted random-sampling approach from half of counties/cities from 23 provinces across China was used. Unmet need was measured as the differences between healthcare services expected and available. We used Cochran-Armitage tests to test linear trends in prevalence of unmet need. Average marginal differences were estimated to measure magnitude of rural-urban disparities in prevalence of unmet need. Changes in rural-urban disparities were decomposed using Blinder-Oaxaca Decomposition technique to logit models. All analysis was performed by Stata 15.0. RESULTS From 2005-2018, decreased trends in prevalence of unmet need were observed (overall: 62.4% to 48.6%; rural: 65.9% to 47.3%; urban: 57.5% to 49.8%) (all ptrend < 0.001). In 2017/2018, urban oldest-old reported greater prevalence of unmet need (average marginal difference, 95% CI: 3.7% [0.4%-7.1%]); affluent oldest-old reported less unmet need than their peers. Oldest-old from Central and Western China reported greater prevalence of unmet need than their Eastern peers. Increases in income (percentages of explained change, overall: 21.3%; rural: 16.9%, urban: 36.9%) mainly contributed to decreased trends in prevalence of unmet need. CONCLUSIONS Oldest-old with socioeconomic disadvantages or living in Central and Western China reported greater prevalence of unmet need. Policy efforts are warranted to ensure equitable access to home visiting services among those oldest-old.
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Affiliation(s)
- Liang Zhang
- School of Business, Wuxi Vocational College of Science and Technology, Wuxi, Jiangsu, China.
| | - Kewei Shi
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, United States
| | - Chengzhong Wang
- Department of Research Management, Xuzhoushi Center of Disease Control and Prevention, Xuzhou, Jiangsu, China.
| | - Zhong Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China; Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, Jiangsu, China.
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Li Z, Xuan M, Gao Y, He R, Qian D, Hung P. Trends in the availability of community-based home visiting services for oldest-old in China, 2005-2018. BMJ Open 2023; 13:e070121. [PMID: 37019484 PMCID: PMC10083737 DOI: 10.1136/bmjopen-2022-070121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES This study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China. DESIGN Repeated, cross-sectional study. SETTING This study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey. PARTICIPANTS A final analytical sample of 38 032 oldest-old individuals. PRIMARY OUTCOME MEASURES Availability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics. RESULTS Of 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018. CONCLUSIONS Despite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.
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Affiliation(s)
- Zhong Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingsong Xuan
- School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Yukuan Gao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ruibo He
- School of Finance and Public Administration, Hubei University of Economics, Wuhan, Hubei, China
| | - Dongfu Qian
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Li Y, Zhang C, Zhan P, Fu H, Yip W. Trends and projections of universal health coverage indicators in China, 1993–2030: An analysis of data from four nationwide household surveys. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2023; 31:100646. [DOI: 10.1016/j.lanwpc.2022.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
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Deng P, Fu Y, Chen M, Si L. Factors associated with health care utilization and catastrophic health expenditure among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:943271. [PMID: 36438282 PMCID: PMC9684646 DOI: 10.3389/fpubh.2022.943271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Cancer, the leading cause of mortality in China, is a significant burden on patients, their families, the medical system, and society at large. However, there is minimal data on health service utilization and catastrophic health expenditure (CHE) among cancer patients in China. The objective of this study was to identify factors associated with health care utilization and CHE in Chinese cancer patients. Methods The 2018 wave of a nationally representative dataset, the China Health and Retirement Longitudinal Study, was used in our study. Of 18,968 respondents recruited for the analysis, 388 were clinically diagnosed with cancer. CHE was defined as household health expenditure that exceeded 40% of non-food household expenses. A binary logistic regression model was used to identify the risks of cancer exposure among all participants, along with the likelihood of CHE in households with cancer patients at the 40% threshold. A negative binomial regression model was used to identify determinants of health service utilization among cancer patients. Results Contracting a family physician (incidence rate ratio IRR: 2.38, 1.18-4.77), Urban Employee Basic Medical Insurance (IRR: 4.02, 1.91-8.46, compared to the uninsured), Urban and Rural Resident Basic Medical Insurance (IRR: 3.08, 1.46-6.49, compared to the uninsured), and higher per-capita household consumption were positively associated with inpatient service utilization. Patients with a college education and above reported a greater number of outpatient visits (IRR: 5.78, 2.56-13.02) but fewer inpatient hospital days (IRR: 0.37, 0.20-0.67). Being diagnosed with a non-cancer chronic non-communicable disease was associated with an increased number of outpatient visits (IRR: 1.20, 1.10-1.31). Of the 388 participants, 50.1% of households had CHE, which was negatively correlated with a larger household size (odds ratio OR: 0.52, 0.32-0.86) and lower socioeconomic status [for quintile 5 (lowest group) OR: 0.32, 0.14-0.72]. Conclusions The socioeconomic characteristics of cancer patients had a considerable impact on their healthcare utilization. Individualized and targeted strategies for cancer management should be implemented to identify high-risk populations and trace the utilization of care among Chinese cancer patients. Strategic purchasing models in cancer care and social health insurance with expanded benefits packages for cancer patients are crucial to tackling the cancer burden in China.
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Affiliation(s)
- Penghong Deng
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Center for Global Health, Nanjing Medical University, Nanjing, China,*Correspondence: Mingsheng Chen
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia,The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
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Ren Y, Zhou Z, Cao D, Ma BH, Shen C, Lai S, Chen G. Did the Integrated Urban and Rural Resident Basic Medical Insurance Improve Benefit Equity in China? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1548-1558. [PMID: 35514010 DOI: 10.1016/j.jval.2022.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The reform of merging 2 major health insurance schemes into Urban and Rural Resident Basic Medical Insurance (URRBMI) is recognized as a vital step to safeguard equal healthcare and benefit to each enrollee in China. Against this backdrop, this article aims to evaluate the impact of URRBMI integration on benefit and its contribution to benefit equity. METHODS The data of this study were derived from the China Health and Retirement Longitudinal Study 2011 and 2015. A total of 11 383 individuals were included in the final sample. Coarsened exact matching with difference-in-difference approach was firstly adopted to investigate the treatment effects of URRBMI on benefits. Next, the decomposition of concentration index (CI) was conducted to explore the contribution of URRBMI to benefit equity. RESULTS The coarsened exact matching with difference-in-difference results revealed that the consolidation of URRBMI has significantly improved outpatient benefit. The decomposition results showed that the contribution rates of URRBMI scheme to outpatient benefit rate (CI -0.0114), benefit probability (CI 0.0673), compensation fee (CI 0.0076), and reimbursement ratio (CI 0.0483) were 11.26%, -3.38%, -7.67%, and -0.81%, suggesting that this reform makes contribution to the propoor inequity in the outpatient benefit rate and relieves the prorich inequity in outpatient benefit probability and the degree of benefits. CONCLUSIONS The findings of this study provide novel evidence of enhanced benefits and benefit equity for outpatient care with the integration of URRBMI. Further efforts should be made to the expansion of URRBMI coverage and the elimination of income disparities that affecting benefit equity.
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Affiliation(s)
- Yangling Ren
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China.
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Bernice Hua Ma
- Centre for Health Economics, Monash University, Melbourne, Australia.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia
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Burden of lymphoma in China, 1990-2019: an analysis of the global burden of diseases, injuries, and risk factors study 2019. Aging (Albany NY) 2022; 14:3175-3190. [PMID: 35398840 PMCID: PMC9037266 DOI: 10.18632/aging.204006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022]
Abstract
Background: China is facing an aggravating disease burden of lymphoma. However, accurate information about lymphoma burden at the national and provincial levels is limited. Results: The estimated number of disability-adjusted life years were 86,171.85 for Hodgkin lymphoma and 1,306,247.77 for non-Hodgkin lymphoma with the age-standardized rates of 4.95 and 71.00, respectively, per 100,000 population. There were estimated 9,468 new cases and 2,709 Hodgkin lymphoma-related deaths, and 91,954 new cases and 44,310 non-Hodgkin lymphoma-related deaths. Older individuals had a higher lymphoma burden. The age-standardized disability-adjusted life year rate in men was approximately two-folds higher than that in women. Moreover, disparities in lymphoma burden were observed across the provinces. Between 1990 and 2019, the disability-adjusted life year number decreased by 57.8% for Hodgkin lymphoma, and increased by 100.9% for non-Hodgkin lymphoma. Conclusion: Burden of lymphoma showed heterogeneous change patterns varied according to sex, age, and provinces, with a steady decrease in Hodgkin lymphoma and a significant increase in non-Hodgkin lymphoma during the past three decades. Methods: Following the analytical strategy used in the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, age-, sex-, and province-specific incidence, mortality, and prevalence of Hodgkin lymphoma and non-Hodgkin lymphoma were analyzed. Lymphoma burden was assessed by incidence, mortality, prevalence, and disability-adjusted life year.
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Pu X, Wang Y, Zhang W, Zeng M. Can Basic Medical Insurance Reduce Elderly Family Income Inequality in China? Front Public Health 2022; 10:838733. [PMID: 35242735 PMCID: PMC8885622 DOI: 10.3389/fpubh.2022.838733] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Basic medical insurance is the critical medical security system to realize common prosperity in China. This study explores the impact of basic medical insurance on elderly family income inequality in China using the China Family Panel Studies (CFPS) data in 2018. Our finding shows that basic medical insurance is significantly negatively correlated with elderly family income inequality, indicating basic medical insurance has a positive impact on narrowing the elderly family income inequality. The heterogeneity analysis shows that basic medical insurance has a more significant reduction effect among the eastern elderly and the younger elderly family. The results also suggest that health performance significantly mediates the relationship between basic medical insurance and elderly family income inequality. This study implies that the Chinese government should increase the proportion of basic medical insurance reimbursement and expand the scope of reimbursement for basic medical insurance to realize income fairness among elderly families.
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Affiliation(s)
- Xiaohong Pu
- School of Public Administration, Sichuan University, Chengdu, China
| | - Yilong Wang
- School of Public Administration, Sichuan University, Chengdu, China
- School of Management, Northwest Minzu University, Lanzhou, China
| | - Weike Zhang
- School of Public Administration, Sichuan University, Chengdu, China
- *Correspondence: Weike Zhang
| | - Ming Zeng
- School of Public Administration, Sichuan University, Chengdu, China
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Iyalomhe FO, Adekola PO, Cirella GT. Community-based health financing: empirical evaluation of the socio-demographic factors determining its uptake in Awka, Anambra state, Nigeria. Int J Equity Health 2021; 20:235. [PMID: 34702289 PMCID: PMC8549318 DOI: 10.1186/s12939-021-01574-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is an increasing global concern of financing poor people who live in low- and middle-income countries. The burden of non-communicable diseases of these people is, by in large, connected to a lack of access to effective and affordable medical care, weak financing, and delivery of health services. Policymakers have assumed, until recently, that poor people in developing countries would not pay health insurance premiums for the cost of future hospitalization. The emergence of community-based health financing (CBHF) has brought forth a renewed and empowered alternative. CBHF schemes are designed to be sustainable, varying in size, and well organized. Developing countries, such as Nigeria, have been testing and finetuning such schemes in the hope that they may 1 day reciprocate high-income countries. METHODS A sample size of 372 respondents was used to assess the slums of Awka, the capital city of Anambra State, Nigeria, and empirically evaluate the socio-demographic characteristics of those who uptake CBHF using the provider Jamii Bora Trust (JBT). Cross-sectional research used a quantitative research approach with the instrumentality of structured questionnaires. Descriptive analysis was adopted to determine the socio-demographic characteristics of those who have CBHF uptake in Awka and evaluate the presence and benefits of CBHF in the city's slums. RESULTS The results show that more youth and middle-aged persons from 18 to 50 years are more insured (i.e., 73.8% combined) than those who are over 50 years of age. Gender distribution confirm more females (i.e., 61.9%) to be health-insured than their male counterpart (i.e., 38.1%). This perhaps reflected the reproductive roles by women and the fact that women have better health-seeking behavioral attitude. Moreover, the results correlate with previous studies that confirm women are more involved in local sustainable associations in low-income settings, of this nature, in sub-Saharan Africa. Corroborating this further, married people are more insured (i.e., 73.8%) than those who are not married (i.e., 26.2%) and insured members report higher use of hospitalization care than the non-insured. CONCLUSION CBHF uptake favored members in the lower income quintiles who are more likely to use healthcare services covered by the JBT scheme. This confirmed that prepayment schemes and the pooling of risk could reduce financial barriers to healthcare among the urban poor. Recommendations are suggested to improve enrollment levels in the CBHF programs.
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Affiliation(s)
- Felix O Iyalomhe
- Department of Biological and Environmental Science, Kampala International University, 20000, Kampala, Uganda.
- Department of Environmental Sciences, National Open University of Nigeria, Abuja, 900211, Nigeria.
- Polo Centre of Sustainability, 18100, Imperial, Imperia, Italy.
| | - Paul O Adekola
- Polo Centre of Sustainability, 18100, Imperial, Imperia, Italy
- Demography and Social Statistics Programme, Department of Economics and Development Studies, College of Management and Social Sciences, Covenant University, Ota, 112233, Nigeria
- Centre for Economic Policy and Development Research, Covenant University, Ota, 112233, Nigeria
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Hu D, Yan W, Zhu J, Zhu Y, Chen J. Age-Related Disease Burden in China, 1997-2017: Findings From the Global Burden of Disease Study. Front Public Health 2021; 9:638704. [PMID: 33732678 PMCID: PMC7959714 DOI: 10.3389/fpubh.2021.638704] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The population is aging much faster in China than other low- and middle-income countries. With the accelerated aging of the population, incidence and disease burden of age-related diseases have also continued to increase. Exploring the burden of age-related diseases is crucial for early disease prevention, assessing the extent of population aging, and achieving the goal of healthy aging. Methods: We used the dataset from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), and selected data on incidence, prevalence, and disease burden in China, in 1997, 2007, and 2017. We classified age-related diseases, which were defined as diseases in which the incidence rate increased quadratically with age in the adult population. Additionally, we described the changes in age-related diseases during the study period by different GBD categories. It also measured changes in the age-related disease burden in our study period, including disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD). Finally, we compared the differences in the age-related disease burdens for men and women. Results: Among the 293 diseases listed in the GBD study, 69 in 2017, 78 in 1997 and 72 in 2007 were identified as age-related diseases. More than half of the age-related diseases belonged to non-communicable diseases (NCDs) in our study period. The rate of age-standardized age-related disease burden decreased between 1997 and 2017. DALYs decreased by 24.89% for non-age-related diseases and by 50.15% in age-related diseases from 1997 to 2017. The age-related disease burden of men was higher than that of women; we found a decreasing trend, with −46.23% in men and −54.90% in women. Conclusions: Comparing characteristics of the aging population in China and the world, we found that China does not have the typical disease characteristics of aging society. Currently, China faces the dual threat of NCDs and communicable diseases, and NCDs account for the vast majority of the age-related disease burden. Our health systems should focus on disease prevention and early detection among the entire population, instead of treatment. Further studies should focus on reducing the duration and severity of morbidity in later life.
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Affiliation(s)
- Dan Hu
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China.,Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China
| | - Wu Yan
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jing Zhu
- Division of Medical Affairs, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Zhu
- Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaying Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China.,Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China
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