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Xu P, Zhao N, Wang J. Knowledge, attitude, and practice toward osteoporosis among patients with chronic kidney disease in Zhejiang. Medicine (Baltimore) 2024; 103:e38153. [PMID: 38758880 PMCID: PMC11098230 DOI: 10.1097/md.0000000000038153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
Patients with chronic kidney disease (CKD) are considered high-risk group for osteoporosis. However, the current understanding of their knowledge, attitude, and practice toward osteoporosis remains unclear. CKD patients were recruited from Li Huili Hospital, Ningbo Medical Center between March 2023 and June 2023. A self-designed questionnaire was used to collect the participant's demographic characteristics and knowledge, attitude, and practice toward osteoporosis. A total of 500 valid questionnaires were included in the analysis, with participants aged 51.08 ± 14.76 years. The mean scores for knowledge, attitude, and practice were 6.67 ± 3.04 (range: 0-11), 33.99 ± 3.37 (range: 10-50), and 35.29 ± 5.54 (range: 9-45), respectively. Pearson correlation analysis revealed significant positive associations between knowledge and attitude scores (r = 0.440, P < .001), knowledge and practice scores (r = 0.376, P < .001), as well as attitude and practice scores (r = 0.403, P < .001). Structural equation modeling revealed direct associations between knowledge and attitude (path coefficient = 0.488, P < .001), and between attitude and practice (path coefficient = 0.485, P < .001). The knowledge also exhibited a directly positive effect on practice (path coefficient = 0.449, P < .001). Undergoing glucocorticoid therapy (odd ratio [OR] = 2.353, 95% confidence interval [CI]: 1.022-5.418, P = .044) and osteoporosis osteoporosis (OR = 1.565, 95% CI: 1.011-2.421, P = .044) were positively associated with knowledge. Moreover, disease duration >1 year was positively associated with practice (OR = 3.643, 95% CI: 1.754-7.565, P < .001). CKD patients demonstrated moderate knowledge, neutral attitude, and moderate practice toward osteoporosis. To address the practice gaps of CKD patients toward osteoporosis, targeted educational interventions and attitude support programs can be developed.
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Affiliation(s)
- Pengjie Xu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Nadan Zhao
- Department of Radiology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
| | - Jiangdong Wang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China
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Liu S, Cai Q, Wang M, Di K. Urban public services and fertility intentions of internal migrants in China. PLoS One 2024; 19:e0300345. [PMID: 38547133 PMCID: PMC10977766 DOI: 10.1371/journal.pone.0300345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
As China continues to implement its progressive fertility promotion policy, there has been a drastic decline in the fertility rate. Given that the migrant population constitutes more than a quarter of China's total population, enhancing the willingness of this demographic to have additional children through policy-guided urban public services is pivotal for optimizing China's population development strategy. This study analyzes the influence of urban public services on the reproductive intentions of the migrant population, utilizing data from 110,667 migrant families with one child, drawn from China's Migrant Population Dynamic Monitoring data in 2016 and 2018. The data analysis reveals several key findings: (1) Urban public services, overall, exhibit a notable positive effect on the willingness of the migrant population to have more children, albeit with limitations and a declining trend. (2) Among urban public services, primary basic education significantly impacts the willingness of the migrant population to expand their families. (3) Large cities have created a 'reverse screening' effect on the migrant population, leading to differential access to public services. This scenario caters effectively to the high human capital migrant individuals while reducing accessibility to livelihood public services for the low human capital migrant population. This paper critically evaluates China's progressively adjusted fertility policy from the perspective of the migrant population. It underscores the necessity of establishing a comprehensive fertility support policy system across China.
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Affiliation(s)
- Sichen Liu
- College of Economics and Management, Wuhan University, Wuhan, Hubei Province, China
| | - Quanling Cai
- Department of Management and Economics, Tianjin University, Tianjin, China
- College of Politics and Public Administration, Qinghai Minzu University, Xining, Qinghai Province, China
| | - Mingxing Wang
- College of Finance and Economics, Qinghai University, Xining, Qinghai Province, China
| | - Kaisheng Di
- Department of Management and Economics, Tianjin University, Tianjin, China
- College of Politics and Public Administration, Qinghai Minzu University, Xining, Qinghai Province, China
- Department of Party Committee, Party School of the Qinghai Provincial Committee of CPC, Xining, Qinghai Province, China
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Dong B. A study on the impact and mechanism of action of public health education on the health of the migrant population: evidence from the 2018 China migrants dynamic survey. Front Public Health 2024; 12:1308751. [PMID: 38454992 PMCID: PMC10919148 DOI: 10.3389/fpubh.2024.1308751] [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: 10/07/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
Background China has the world's largest mobile population. As mobility increases, ensuring the health protection of this population is receiving more attention. Strengthening public health education is a crucial measure to improve their health and achieve equal access to basic public health services in China. Previous research has demonstrated that public health education has an impact on the health of mobile populations. However, there has been limited investigation into the mediating pathways through which health education influences the health of mobile populations, and few studies have examined the heterogeneity of this effect. Objectives The aim of this study was to analyze the impact of public health education on the health of the mobile population and its mechanism of action. Additionally, we aimed to explore the differences in this impact among different subdivided groups. Methods This paper analyses the impact of public health education on the health of the mobile population using the 2018 China Migrant Dynamic Survey (CMDS) Data,. The data was cleaned and 4,034 people were included in the analysis. The study employed ordered logistic regression modeling to analyze the mediating pathways through which health education affects health. Additionally, binary logistic regression model, probit model, propensity score matching method and instrumental variables were used to verify the robustness of the results. Results The self-assessed health status of the mobile population was good, and 82.10% of them accepted public health education. However, 17.89% of the mobile population did not receive any health education. Acceptance of health education can help improve the health status of the mobile population (OR = 1.178, 95% CI = 0.979-1.418). The study found that public health education can positively impact the health of mobile populations by influencing their health and hospitalization behaviors, as well as their social support. The analysis of heterogeneity revealed that the impact of public health education is more significant among rural, middle-aged, low-education, and low-income groups of the mobile population. Conclusion Public health education can have a positive impact on the health of the migrant populations. To further improve health education for this group, it is necessary to actively promote the establishment of health records for the migrant population, to facilitate the contracting of family doctors by the migrant population, to improve the accessibility to hospitalization services, reduce the burden of hospitalization costs, and enhance social support. Simultaneously, it is essential to offer precise and varied health education to the migrant population based on their characteristics, to promote equity among diverse groups of individuals. These findings not only help to enrich theoretical research on health education for migrant populations and the health of migrant populations but also help to improve the level of public health education for migrant populations and improve the health protection of migrant populations.
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Affiliation(s)
- Bo Dong
- Wuhan University, Wuhan, China
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Liu S, Qin B, Wang D. How does social integration work when older migrants obtain health services from community? Evidence from national database in China. Front Public Health 2023; 11:1283891. [PMID: 38192547 PMCID: PMC10773583 DOI: 10.3389/fpubh.2023.1283891] [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: 08/27/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024] Open
Abstract
Background The roles of community are often overlooked when studying the older migrants' health issues, and more importantly, the mediating effect of social integration on the health of older migrants were rarely investigated empirically. Methods This study developed comprehensive index to explore this relationship. With data from the 2017 China Migrants Dynamic Survey, the study first examined the potential linkage between community-based health services and the health of older migrants. Ordered logit regressions was carried to investigate whether the self-rated health of older migrants is related to health education and health records provided by community, then the Causal Stepwise Regression and bootstrap method was used to looked into the potential mediation effect. Results The findings showed that older migrants with more community-based health education had higher self-rated health (β = 0.038, SE = 0.009, p < 0.001). However, the community-based health records were not associated with older migrants' health. Moreover, higher levels of social integration were associated with community health education (β = 0.142, SE = 0.014, p < 0.001), and social integration was positively associated with older migrants' health (β = 0.039, SE = 0.002, p = 0.024), indicating the mediation role of social integration. Conclusion The vital role of community-based health education in improving the health of older migrants was found, and social integration plays a mediating role.
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Affiliation(s)
- Shenshen Liu
- Department of Disease Control and Prevention, General Hospital of Central Theater Command, Wuhan, China
| | - Bo Qin
- Hubei Key Laboratory for Kidney Disease Pathogenesis and Intervention, Hubei Polytechnic University School of Medicine, Huangshi, China
| | - Dongyang Wang
- Department of Nursing, The Third People's Hospital of Henan Province, Zhengzhou, China
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Duan Z, Feng Y, Xu S, Gao D, Ji Y, Sun X, Chen R, Wang Y. The role of childhood left-behind experience on childhood trauma exposure and mental health outcomes: a propensity score matching (PSM) analysis. J Public Health (Oxf) 2023; 45:785-793. [PMID: 37210629 DOI: 10.1093/pubmed/fdad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND China has a significant number of left-behind families. This study focuses on the long-term effects of childhood left-behind experience on different type of childhood trauma and mental health outcomes in later life development. METHODS participants were 67 795 Chinese young adults. Psychosocial characteristics were screened by sleep quality, the nine-item Patient Health Questionnaire for depressive symptoms, the generalized anxiety disorder-7 for anxiety symptoms, trauma screening questionnaire for post-traumatic stress, a short form of the Childhood Trauma Questionnaire for childhood trauma. Propensity score matching (PSM) and multivariate linear regression were applied to analyze the data. RESULTS the results of the post-PSM analysis showed that the distributions of propensity scores for the two groups were approximately equal. And the total sample size in post-analysis dropped to 2358 (Nnuclear family = 1179, Nleft-behind family = 1179), with unmatched cases excluded. Post-matching results showed that the students from left-behind family were significantly associated with severer post-traumatic stress (b = 0.39, 95% CI = [0.15, 0.62]), loneliness (b = 0.29, 95% CI = [0.16, 0.42]), depressive symptoms (b = 0.44, 95% CI = [0.06, 0.82]) and CTQ-physical neglect (b = 0.34, 95% CI = [0.11, 0.58]). CONCLUSION our study showed that childhood left-behind experiences are tightly related to childhood trauma experience and mental health issues (post-traumatic stress, loneliness and depression) in late adolescents.
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Affiliation(s)
- Zhizhou Duan
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
- Preventive Health Service, Jiangxi provincial people's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
| | - Desheng Gao
- School of Marxism, Harbin Institute of Technology, Harbin, China
| | - Yan Ji
- School of Marxism, Harbin Institute of Technology, Harbin, China
| | - Xi Sun
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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Gao T, Yan G, Zhang M, Leng B, Jiang F, Mi W. Effect of social integration on family doctor contracting services among migrant populations in China: a national cross-sectional survey. Fam Pract 2023; 40:538-545. [PMID: 37555256 DOI: 10.1093/fampra/cmad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The family doctor (FD) contracting system is a key reform in the development of the Chinese health system, and is considered an effective way to ensure equitable access to healthcare services. This study investigates the effects of social integration on FD contracting services among migrant populations. METHODS In total, 120,106 respondents from the 2018 China Migrants Dynamic Survey were included in this study. Two multivariate regression models were used to estimate the effect of social integration and other factors on FD contracting services among migrant populations. RESULTS This study found that only 14.0% of the migrant populations had a FD. Multiple dimensions of social integration and some covariates were shown to be positively associated with FD contracting services, including average monthly household income, local medical insurance (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.29-1.39), employment status (OR = 0.86, 95% CI = 0.82-0.91), settlement intention (OR = 1.15, 95% CI = 1.09-1.22), received health education (OR = 4.88, 95% CI = 4.51-5.27), sex (OR = 1.16, 95% CI = 1.12-1.20), age (OR = 1.66, 95% CI = 1.51-1.82), marital status (OR = 1.38, 95% CI = 1.31-1.46), sickness within a year (OR = 0.84, 95% CI = 0.79-0.89), and flow range (OR = 1.12, 95% CI = 1.07-1.16). CONCLUSIONS All dimensions of social integration, including economic integration, social identity, and social involvement, are associated with FD contracting services among migrant populations. Policymakers should focus on improving the signing rates of migrant populations and implement more effective measures to enhance their social integration, such as settlement incentives and encouraging social participation.
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Affiliation(s)
- Tiantian Gao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Genquan Yan
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Meiying Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bing Leng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fan Jiang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Wei Mi
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Xing Y, Zhang L, Zhang Y, He R. Relationship between social interaction and health of the floating elderly population in China: an analysis based on interaction type, mode and frequency. BMC Geriatr 2023; 23:662. [PMID: 37845627 PMCID: PMC10580520 DOI: 10.1186/s12877-023-04386-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Although the health of the floating elderly population is an important part of active and healthy ageing, it is neglected in current Chinese society. Based on the general consensus that social interaction can affect the health of the floating population, this study explored whether the interaction type, mode and frequency influenced the health of the floating elderly population in China and investigated the variability of these influential effects. METHODS This study used the China Migrant Population Dynamic Survey Data 2017 and selected 5239 floating elderly individuals over 60 years old. Self-rated health was used to assess the comprehensive health status of respondents. Social interaction was measured by the interaction type, mode and frequency. Descriptive statistical analysis was used to analyse the health and social interaction status. An ordinal probit model was used to estimate the influential effects and differences on health caused by social interaction. The 2SLS model was used to examine the mutual causality relationship between interaction frequency and health, and a robustness test was conducted. RESULTS A total of 44.6% interacted with local residents, 14.2% participated in interaction activities based on geographical relations, and only 4.3% and 7% participated in interactions based on business and interest, respectively. Interacting with natives improved individuals' self-rated health by 18.5%; specifically, geographical interaction increased self-rated health by 40.9%, occupational interaction increased it by 25.2%, interest-based interaction increased it by 41.2%, and interaction frequency improved the self-rated health (β = 0.128). In addition, sex, education level, personal income, and floating into the eastern region had a positive effect on individuals' health. However, age, spouse and hukou exerted a negative effect. CONCLUSIONS This study demonstrated that interacting with local residents could improve the health of floating elderly population, and revealed that interest-based interaction and their frequency had a positive impact on health. The government should speed up the construction of the voluntary service system and encourage the floating elderly population to realize their personal value in social interaction. In addition, the reform of the hukou system should be further promoted, so as to remove institutional barriers to the social interaction.
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Affiliation(s)
- Yiqing Xing
- School of Political Science and Public Administration, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Liang Zhang
- School of Political Science and Public Administration, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Yuelu Zhang
- School of Grammar and Law, Huazhong Agricultural University, 1 Shizishan Street, Hongshan District, Wuhan City, Hubei Province, China
| | - Ruibo He
- School of Political Science and Public Administration, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan City, Hubei Province, China.
- School of Finance and Public Administration, Hubei University of Economics, 8 Yangqiaohu Avenue, Jiangxia District, Wuhan City, Hubei Province, China.
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Wang X, Liu J, Zhu J, Bai Y, Wang J. The association between social integration and utilization of primary health care among migrants in China: a nationwide cross-sectional study. Int J Equity Health 2023; 22:210. [PMID: 37814276 PMCID: PMC10561491 DOI: 10.1186/s12939-023-02018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Migrants is a large population in China. To improve the health and wellbeing of migrants is a critical policy and social issue in China, and to enhance the utilization of primary health care by migrants is one of the most important approaches in promoting equity in health. However, there exists little research about the association between social integration and the utilization of primary health care. To address the research gap, this research aims at exploring the relation between social integration and the utilization of primary health care among migrants in China. METHODS Using the national data from China Migrants Dynamic Survey (CMDS) in 2017, 169,989 migrants were included in this study. Social integration was measured by social communication, acculturation and self-identity, with 8 indicators. The utilization of primary health care was measured by the receiving of health education on infectious diseases (ID) and noncommunicable diseases (NCD) as well as the first visit institution when migrants were sick. After the descriptive statistical analysis, binary logistic regression was employed to evaluate the association between social integration and the utilization of primary health care. RESULTS 65.99% of the migrants received health education on infectious diseases (ID), 40.11% of the migrants received health education on noncommunicable diseases (NCD) and 8.48% of the migrants chose to go to Community Health Center (CHC) seeking for health services. There was a positive effect of social organization participation, the influence of hometown customs, differences of hygiene habits between migrants and local people, integration willingness and evaluation of identity on the receiving of health education on ID and NCD, as well as a positive effect of civil activities engagement and differences of hygiene habits between migrants and local people on the utilization of CHC after getting sick. CONCLUSIONS Social integration was associated with the utilization of primary health care among migrants in China. Generally speaking, greater social integration was associated with higher possibility of receiving health education on ID and NCD. However, the effect of social integration on the utilization of CHC was more complex among different indicators. There should be more policy interventions to improve the social integration of migrant which help them to get familiar with the health resource available, as well as improve the capacity of CHC.
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Affiliation(s)
- Xueyao Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
- School of Public Administration and Policy, Renmin University of China, Beijing, 100872 China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100080 China
- Institute for Global Health and Development, Peking University, Beijing, 100871 China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, 100083 China
| | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB UK
| | - Yang Bai
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
- School of Public Administration and Policy, Renmin University of China, Beijing, 100872 China
| | - Jun Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
- Beijing Famous Cultural Artist Studio--Health Beijing Governance Theory Creation Studio, Beijing, 100872 China
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Self-rated Health and Objective Health Status Among Rural-to-Urban Migrants in China: A Healthy Housing Perspective. POPULATION RESEARCH AND POLICY REVIEW 2023. [DOI: 10.1007/s11113-023-09752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Lin X, Mao X, Ai F, Yao W. Factors influencing utilization of communicable disease prevention and treatment education among the floating population: a cross-sectional study in China. BMC Public Health 2023; 23:207. [PMID: 36721260 PMCID: PMC9887564 DOI: 10.1186/s12889-023-15126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/09/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In China, communicable diseases (CD) have a negative impact on public health and economic stability. The influx of migrants, who make up a substantial portion of China's population and continue to rapidly expand, has seriously hampered CD prevention and control, needing special care. This study aimed to identify key factors influencing the utilization of CD prevention and treatment education (CDPTE) among the floating population. We are confident that the findings will highlight obstacles facing CDPTE among the migrants, and guide future development prevention, treatment of CD, and health education services. METHODS A sample of migrants aged 15 years and above in 32 provincial units nationwide in 2018 was recruited by stratified multi-stage proportional to population size sampling (PPS). A structured questionnaire survey was conducted via face-to-face interviews. Subsequently, the Anderson health service utilization model was used as the theoretical framework and SPSS 26.0 statistical software was applied to analyze the data. The statistical description of the current situation of CDPTE acceptance and the chi-square test were used to compare the differences in CDPTE acceptance by different characteristics. Multivariate logistic regression was used to analyze key factors affecting the use of CDPTE among migrants. RESULTS A total of 40.1% of the recruited participants reported receiving education on CD prevention and treatment, primarily delivered through traditional transmission media. Multilevel logistic regression results revealed that male migrants, aged 30-49 years, unmarried, with higher educational attainment, an average monthly household income of CNY 7,500-9,999 (or US$1,176-1,568), working more than 40 h per week, flowing into the Central and Western regions, migrated in the province, self-rated health, contracted family doctors and those with health records were more likely to receive CDPTE (p < 0.05). CONCLUSION Our findings revealed unsatisfactory acceptance of education on CD prevention and treatment among migrants, implying that health education should be strengthened further. Publicity of relevant policies and works should be strengthened and specific interventions should be developed for key regions as well as vulnerable groups to enhance CDPTE. More financial support should also be provided to improve the quality of health education.
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Affiliation(s)
- Xiaodan Lin
- grid.284723.80000 0000 8877 7471School of Health Management, Southern Medical University, Guangzhou, People’s Republic of China
| | - Xiuhua Mao
- grid.284723.80000 0000 8877 7471School of Health Management, Southern Medical University, Guangzhou, People’s Republic of China
| | - FuZhi Ai
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
| | - Weiguang Yao
- School of Health Management, Southern Medical University, Guangzhou, People's Republic of China.
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Zhang H, Wu Y, Sun W, Li W, Huang X, Sun T, Wu M, Huang Z, Chen S. How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect. Front Public Health 2023; 10:1030323. [PMID: 36684939 PMCID: PMC9845872 DOI: 10.3389/fpubh.2022.1030323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
Background Continuity is crucial to the health care of the internal migrant population and urgently needs improvements in China. Chinese government is committed to promoting healthcare continuity by improving the people-centered integrated care (PCIC) model in medical alliances. However, little is known about the driving mechanisms for continuity. Methods We created the questionnaire for this study by processes of a literature research, telephone interviews, two rounds of Delphi consultation. Based on the combination of quota sampling and judgment sampling, we collected 765 valid questionnaires from developed region and developing region in Zhejiang Province. Structural equation models were used to examined whether the attributes of PCIC (namely coordination, comprehensiveness, and accessibility of health care) associated with continuity, and explored the moderated mediating role of respect. Results The result of SEM indicated that coordination had direct effect on continuity, and also had mediating effect on continuity via comprehensiveness and accessibility. The hierarchical linear regression analysis showed that the interactive items of coordination and respect had a positive effect on the comprehensiveness (β = 0.132), indicating that respect has positive moderating effect on the relationship between coordination and comprehensiveness. The simple slope test indicated that in the developed region, coordination had a significant effect on comprehensiveness for both high respect group(β = 0.678) and low respect group (β = 0.508). The moderated mediation index was statistically significant in developed areas(β = 0.091), indicating that respect had moderated mediating effect on the relationship between coordination and continuity via comprehensiveness of healthcare in the developed region; however, the moderated mediation effect was not significant in the developing region. Conclusion Such regional differences of the continuity promoting mechanism deserve the attention of policy-makers. Governments and health authorities should encourage continuity of healthcare for migrants through improving the elements of PCIC-coordination, comprehensiveness and accessibility of healthcare, shaping medical professionalism of indiscriminate respect, and empowering migrants to have more autonomy over selection of services and decisions about their health.
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Affiliation(s)
- Hao Zhang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yan Wu
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Wei Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Wuge Li
- Department of Clinical Medicine, School of Clinical Medicine, Hangzhou Medical College, Hangzhou, China
| | - Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Tao Sun
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Mengjie Wu
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Zhen Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Shanquan Chen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Zhou D, Zhan Q, Wen X. How does digital life influence the health service use among rural residents? Evidence from China. Technol Health Care 2023; 31:2091-2106. [PMID: 37483027 DOI: 10.3233/thc-220631] [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] [Indexed: 07/25/2023]
Abstract
BACKGROUND The Healthy China strategy is an important development objective of the 14th Five-Year Plan and Vision 2035 in China, while health service use in rural China has been a weak link in this strategy. OBJECTIVE Nowadays, people's health service use will be influenced by digital technology due to the arrival of the Digital Age, and that is the reason why our interest is to discuss the effect of digital life on health service use among rural residents. METHODS We use the data from the China Family Panel Studies (CFPS) 2020 to examine the effect of digital life on health service use among rural residents, and we use Instrumental Variables method to control the endogenous problem and use KHB model to discuss the mechanism of this effect. RESULTS It was found that digital life has increased the health service use among rural residents significantly, and this result has been verified by robust test and Instrumental Variables method. Besides, digital life can increase health service use through the information channel effect and the health literacy effect indirectly. Moreover, digital life has a more significant impact on the residents with low social capital, low physical capital and low social trust, which represents the inclusivity of digital life. CONCLUSION The results of our paper will be helpful to examine the effect of the digital policy on promoting the health service use in rural China, and our findings will provide evidence of how to use digital life to enhance health service use among rural residents. Based on this, the government should take measures to eliminate the digital divide between urban and rural areas by promoting the level of digital life among rural residents, paying more attention to the digital literacy development among them, and forging ahead toward the great goal of the Healthy China under the Digital Age.
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Affiliation(s)
- Deshui Zhou
- School of Finance and Public Management, Anhui University of Finance & Economics, Bengbu, Anhui, China
| | - Qianqian Zhan
- School of Finance and Public Management, Anhui University of Finance & Economics, Bengbu, Anhui, China
| | - Xin Wen
- School of Humanities and Law (School of Public Administration), Yanshan University, Qinhuangdao, Hebei, China
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13
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Peng B, Ling L. Health service behaviors of migrants: A conceptual framework. Front Public Health 2023; 11:1043135. [PMID: 37124818 PMCID: PMC10140430 DOI: 10.3389/fpubh.2023.1043135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.
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Affiliation(s)
- Boli Peng
- Department of Actuarial Science, School of Insurance, Guangdong University of Finance, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Ling,
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Zhang T, Zhang H, Miao W, Xu J, Shi Q, Liu J, Deng F, He J, Chen F, Kang Z, Wu Q, Tian G. What has affected the governance effect of the whole population coverage of medical insurance in China in the past decade? Lessons for other countries. Front Public Health 2023; 11:1079173. [PMID: 37064691 PMCID: PMC10097977 DOI: 10.3389/fpubh.2023.1079173] [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: 11/07/2022] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Objective This study aimed to explore the current state of governance of full population coverage of health insurance in China and its influencing factors to provide empirical references for countries with similar social backgrounds as China. Methods A cross-sectional quantitative study was conducted nationwide between 22 January 2020 and 26 January 2020, with descriptive statistics, analysis of variance, and logistic regression models via SPSS 25.0 to analyze the effectiveness and influencing factors of the governance of full population coverage of health insurance in China. Results The effectiveness of the governance relating to the total population coverage of health insurance was rated as good by 59% of the survey respondents. According to the statistical results, the governance of the public's ability to participate in insurance (OR = 1.516), the degree of information construction in the medical insurance sector (OR = 2.345), the government's governance capacity (OR = 4.284), and completeness of the government's governance tools (OR = 1.370) were all positively correlated (p < 0.05) on the governance effect of the whole population coverage of health insurance. Conclusions The governance of Chinese health insurance relating to the total population coverage is effective. To effectively improve the effectiveness of the governance relating to the total population coverage of health insurance, health insurance information construction, governance capacity, and governance tools should be the focus of governance to further improve the accurate expansion of and increase the coverage of health insurance.
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Affiliation(s)
- Ting Zhang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hongyu Zhang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenqing Miao
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jinpeng Xu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qi Shi
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jian Liu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Fangmin Deng
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingran He
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Fangting Chen
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zheng Kang
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
- *Correspondence: Zheng Kang
| | - Qunhong Wu
- School of Health Management, Harbin Medical University, Harbin, Heilongjiang, China
| | - Guomei Tian
- Department of Nuclear Medicine, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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15
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Luo Y, Wang S. Urban living and chronic diseases in the presence of economic growth: Evidence from a long-term study in southeastern China. Front Public Health 2022; 10:1042413. [PMID: 36600942 PMCID: PMC9806235 DOI: 10.3389/fpubh.2022.1042413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
High-speed urban development has brought about an increase in per capita income in low- and middle-income countries (LMICs) as well as the high prevalence rate of chronic diseases. Based on a study of chronic diseases from 2011 to 2021 in southeastern China, we used multivariate adjusted logistic regression method to analyze the effect of urban living on the incidence of typical chronic diseases and the trend of such effect with the improvement of public healthcare system. We adopted potential mediating risk factors of urban lifestyles including body mass index (BMI), frequency of dining out, sedentary time, and psychological distress in the adjusted estimation. Baseline results indicate a positive relationship between living in urban areas and the prevalence of type 2 diabetes, hyperlipidemia, and hypertension. Regarding the mediating factors, psychological distress had the highest positive coefficient (Cr) on type 2 diabetes, hyperlipidemia, and hypertension (Cr: 0.4881-0.7084), followed by BMI (Cr: 0.1042-0.1617) and frequency of dining out (Cr: 0.0311-0.0478), and finally, sedentary time (Cr: 0.0103-0.0147). However, regression results on the follow-up survey reveal that trend in the impact of living in urban areas on chronic disease diminished as the level of the healthcare system improved. Additionally, urban living was more positively correlated with the incidence of metabolic disease than with the incidence of cardiovascular disease and cancer. Our findings provide empirical evidence that future urban health planning in LMICs should pay sustained attention to upgrading the level of public health infrastructure covering urban residents as well as rural-to-urban migrants, constructing a long-term dynamic system of chronic disease prevention and control, and regularly monitoring the mental health problems of residents in order to interrupt the process of urban chronic disease prevalence in an early stage.
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Affiliation(s)
- Yixuan Luo
- Department of Economics and Finance, School of Economics and Management, Tongji University, Shanghai, China
| | - Sailan Wang
- Department of Physical Examination, Wuyishan Municipal Hospital, Wuyishan, China
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16
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Zhou Z, Jiang Y, Wu H, Jiang F, Yu Z. The Age of Mobility: Can Equalization of Public Health Services Alleviate the Poverty of Migrant Workers? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013342. [PMID: 36293922 PMCID: PMC9603761 DOI: 10.3390/ijerph192013342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 05/26/2023]
Abstract
Migrants workers are important participants in and contributors to economic and social construction, but they still face the reality of being marginalized. Based on data from the China Migrants Dynamic Survey in 2018, this paper systematically investigated the impact of public health services on the multidimensional poverty of migrant workers. The research found that, first, the current mean of the multidimensional poverty deprivation value of migrant workers is 0.1806, which is one dimension of poverty that exists on average. In addition, migrant workers do not have high access to public health services. The proportions of migrant workers who have not established residents' health files and who have not received public health education are 74.22% and 29.92%, respectively. Second, public health services can significantly alleviate the multidimensional poverty of migrant workers. After mitigating the potential endogeneity problem by the IV-2SLS method and conducting robustness tests by the PSM method, the conclusion is still robust. Further research found that the impact of public health services on the multidimensional poverty alleviation of migrant workers is heterogeneous. The improvement of public health services has the greatest effect on the multidimensional poverty alleviation of the new generation of migrant female workers in the western region. The research in this paper helps to examine and clarify the policy significance of public health services for the multidimensional poverty alleviation of migrant workers and provides empirical evidence for the use of public health services to tackle the poverty problem.
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Affiliation(s)
- Ziming Zhou
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan 430073, China
| | - Yumeng Jiang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China
| | - Haitao Wu
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan 430073, China
| | - Fan Jiang
- Institute of Agricultural Economics and Technology, Hubei Academy of Agricultural Science, Wuhan 430073, China
| | - Zhiming Yu
- School of Business Administration, Zhongnan University of Economics and Law, Wuhan 430073, China
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17
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Zeng W, Wang C, Chen H, Tong B, Li D, Zou Z, Liu P, Yao Y, Shang S. Health status and public health education for internal older migrants in China: Evidence from a nationally representative survey. Front Public Health 2022; 10:937361. [PMID: 35937236 PMCID: PMC9353578 DOI: 10.3389/fpubh.2022.937361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Self-rated health has been widely used as a useful screening tool to subjectively evaluate individuals' health status. Under the context of the rapid growth of aging, there was a dramatic rapid expansion in internal older migrants in China. Serious concerns on the issues of health status continue to attract quite a lot of attention over the past decades. Public health education is one of the most important health care services and methods to improve individuals' health status. However, most previous studies focus on the utilization of public health services such as visiting to doctors, physical examination, and hospitalization. There was limited evidence on the self-rated health and public health education of older migrants. Objectives The study aimed to evaluate self-rated health and the associated determinants in older migrants, as well as to gain a deeper insight into the current status of public health education received by older migrants. Methods We derived the data from the National Migrants Population Health and Family Planning Dynamic Monitor Survey 2018, a cross-sectional study, for secondary analysis. Internal migrants aged 60 years old or over were included in the study. Self-rated health was the dependent variable, while sociodemographic characteristics were the independent variable. The univariate and multivariate analyses were performed by Stata 15.1. Results A total of 5,589 older migrants were included in the study. Eighty-two percentage of older migrants reported healthy self-rated health. There was a significant association between age, gender, minzu, education level, monthly income, public health education, and self-rated health (P < 0.5). However, the proportion of older migrants that received specific public health education was <50%. The most common approach to receiving public health education was through the leaflet, while <20% of older migrants received public health education through public consultation and one-to-one education. Conclusions It was necessary to promote the publicity of public health education in older migrants through easy access and diverse approaches in order to effectively spread health-related knowledge to older migrants to satisfy their health needs and maintain their health.
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Affiliation(s)
- Wen Zeng
- Nursing School of Peking University Health Science Center, Beijing, China
- Guizhou Provincial People's Hospital, Guiyang, China
| | - Cui Wang
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Hongbo Chen
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Beibei Tong
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Dan Li
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Ziqiu Zou
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Peiyuan Liu
- Nursing School of Peking University Health Science Center, Beijing, China
| | - Yuanrong Yao
- Guizhou Provincial People's Hospital, Guiyang, China
- Yuanrong Yao
| | - Shaomei Shang
- Nursing School of Peking University Health Science Center, Beijing, China
- *Correspondence: Shaomei Shang
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18
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Xu X, Zhang Q, You H, Wu Q. Awareness, Utilization and Health Outcomes of National Essential Public Health Service Among Migrants in China. Front Public Health 2022; 10:936275. [PMID: 35899157 PMCID: PMC9309480 DOI: 10.3389/fpubh.2022.936275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background The national essential public health service (NEPHS) has been in operation for more than a decade. Numerous studies examined the utilization of NEPHS by migrants and the factors that influence it, but few examined the effect of NEPHS awareness and utilization on the health of inhabitants, particularly migrants. The purpose of this study is to ascertain the level of awareness and utilization of NEPHS, as well as to examine their health-improving effects on migrants. Methods Based on the data from the 2017 China Migrants Dynamic Survey, linear probability model, ordered logit model and the propensity score matching methods were employed to investigate impact of awareness and utilization of NEPHS on the health among Chinese migrants. Mediating effect model were used to identify the mechanism of the impact of NEPHS on health. Results The findings indicated that migrants' awareness and utilization of NEPHS are still insufficient. After adjusting for other factors, the study discovered that increased awareness and use of NEPHS had a beneficial influence on migrants' self-rated health. Further heterogeneity analysis revealed significant disparities in the health consequences of NEPHS awareness and utilization across subgroups. The effect of increased awareness and usage of NEPHS on health is stronger for middle-aged and elderly people, women, and low-educated migrants with urban household registration. The estimated results of the mediating effect model supported the mechanism that increased NEPHS awareness among the floating population could encourage its utilization and further improve the floating population's health. Conclusions Given that migrants' NEPHS utilization is still low and that NEPHS utilization has a positive effect on health, some targeted strategies, such as a variety of new media communication methods, health education related to occupational disease and tuberculosis prevention, and targeted NEPHS projects for specific groups, such as men, young and middle-aged groups, those with a high level of education, and rural migrants, should be conducted to improve the health of migrants.
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Affiliation(s)
- Xinpeng Xu
- School of Public Health, Nanjing Medical University, Nanjing, China
- Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China
| | - Qinglong Zhang
- Jiangsu Health Development Research Center, Nanjing, China
| | - Hua You
- School of Public Health, Nanjing Medical University, Nanjing, China
- Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China
| | - Qifeng Wu
- School of Public Health, Nanjing Medical University, Nanjing, China
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19
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Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106245. [PMID: 35627780 PMCID: PMC9141272 DOI: 10.3390/ijerph19106245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023]
Abstract
Background: The widening gap in health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Our study explored the existence of differences and the causes of the differences in the health service utilization of older rural-to-urban migrant workers in comparison to older rural dwellers. Further, our study explored socioeconomic differences in health service utilization. Methods: The data from the China Labor-Force Dynamic Survey in 2016, the data from the Urban Statistical Yearbook in 2016, and the Statistical Bulletin were used. Our study applied the latest Andersen Model according to China’s current situation. Before we studied health service utilization, we used Coarsened Exact Matching to control the confounding factors. After matching, 2314 respondents were successfully matched (859 older rural-to-urban migrant workers and 1455 older rural dwellers). The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts. Results: After matching, the probability two-weeks outpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). Overall, 17.98% of the total difference for two-week outpatient utilization was due to the observed influence factors. Moreover, 71.88% of total difference in inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), health self-assessments (80.91%), and the sex ratio in the community (−102.29%) were significant in the differences in inpatient utilization. Conclusions: The findings provide important insights into the socioeconomic differences in health service utilization among older rural-to-urban migrant workers and older rural residents in China. These insights urge the government to take full account of the heterogeneity in designing health security system reform and public health interventions targeting vulnerable groups.
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Pan L, Wang C, Cao X, Zhu H, Luo L. Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095499. [PMID: 35564894 PMCID: PMC9103782 DOI: 10.3390/ijerph19095499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to analyze the health status and unmet healthcare needs, and the impact of related factors, of unwell migrants in Shanghai. A total of 10,938 respondents, including 934 migrants and 10,004 non-migrants, were interviewed in Shanghai’s Sixth Health Service Survey. Descriptive statistics were utilized to present the prevalence of health status and unmet healthcare needs. Binary logistic regression analysis was performed to explore the relationships between predisposing factors, enabling factors, need factors, and health-related behavior and unmet healthcare needs in the Anderson health service utilization model. This study indicated the percentages of migrants having a fair or poor self-evaluated health status (21.09%) and suffering from chronic diseases (72.91%) were lower than those of non-migrants (28.34% and 88.64%, respectively). Migrants had higher percentages of unmet hospitalization needs (88.87%), unmet outpatient care needs (44.43%), and self-medication (23.98%) than those of non-migrants (86.24%, 37.95%, 17.97%, respectively). Migrants enrolled in Urban Employee Basic Medical Insurance were more likely to utilize hospitalization services (OR = 1.457) than those enrolled in other health insurances or uninsured. Need factors had impacts on unwell migrants’ unmet healthcare needs. Other factors, including age and health behavior, were also found to significantly affect unwell migrants’ unmet health service needs. Specific gaps continue to exist between unwell migrants and non-migrants regarding the accessibility of local health services. Flexible policies, such as enhancing the health awareness of migrants and eliminating obstacles for migrants to access medical services, should be implemented to provide convenient and affordable healthcare services to unwell migrants.
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Affiliation(s)
- Lin Pan
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
| | - Cong Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
| | - Xiaolin Cao
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
- Correspondence: (X.C.); (L.L.)
| | - Huanhuan Zhu
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
| | - Li Luo
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
- Correspondence: (X.C.); (L.L.)
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Wu J, Liu R, Shi L, Zheng L, He N, Hu R. Association between resident status and patients' experiences of primary care: a cross-sectional study in the Greater Bay Area, China. BMJ Open 2022; 12:e055166. [PMID: 35338060 PMCID: PMC8961107 DOI: 10.1136/bmjopen-2021-055166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Patients' experiences are important part of health services quality research, but it's still unclear whether patients' experiences are influenced by resident status. This study aimed to evaluate the association between resident status and patients' primary care experiences with the focus on migrants vs local residents. DESIGN A cross-sectional study using multistage cluster random sampling was conducted from September to November 2019. The data were analysed using general linear models. SETTING Six community health centres in Guangzhou, China. PARTICIPANTS 1568 patients aged 20 years or older. MAIN OUTCOME MEASURES Patients' primary care experiences were assessed using the Primary Care Assessment Tool. The 10 domains included in Primary Care Assessment Tool (PCAT) refers to first contact-utilisation, first contact-access, ongoing care, coordination (referral), coordination (information), comprehensiveness (services available), comprehensiveness (services provided), family-centredness, community orientation and cultural competence from patient's perspective. RESULTS 1568 questionnaires were analysed. After adjusting for age, sex, education, annual family income, self-perceived health status, chronic condition, annual medical expenditure and medical insurance, the PCAT total scores of the migrants were significantly lower than those of local residents (β=-0.128; 95% CI -0.218 to -0.037). Migrants had significantly lower scores than local residents in first contact utilisation (β=-0.245; 95% CI -0.341 to -0.148), ongoing care (β=-0.175; 95% CI -0.292 to -0.059), family-centredness (β=-0.112; 95% CI -0.225 to 0.001), community orientation (β=-0.176; 95% CI -0.286 to -0.066) and cultural competence (β=-0.270; 95% CI -0.383 to -0.156), respectively. CONCLUSION Primary care experiences of migrants were significantly worse off than those of local residents, especially in terms of primary care utilisation, continuity and cultural competence. Given the wide disparity in primary care experiences between migrants and local residents, Chinese healthcare system reform should focus on improving quality of primary care services for migrants, overcoming language barriers and creating patient-centred primary care services.
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Affiliation(s)
- JingLan Wu
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - RuQing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Leiyu Shi
- Department of Health Policy & Management, School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lingling Zheng
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ning He
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
| | - Ruwei Hu
- Department of Health Management, Sun Yat-Sen University School of Public Health, Guangzhou, Guangdong, China
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22
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Peng H, Sun M, Hu X, Han H, Su J, Peng E, Wiley J, Lommel L, Chen JL. Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China. PeerJ 2022; 10:e13365. [PMID: 35535240 PMCID: PMC9078134 DOI: 10.7717/peerj.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/10/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China. METHODS We conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg). RESULTS Overall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP. CONCLUSIONS This study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.
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Affiliation(s)
- Hua Peng
- Department of Nursing, Xiangya Hospital of Central South University, Changsha, China
| | - Mei Sun
- Community Nursing Department, Xiangya Nursing School of Central South University, Hunan Women Research Association, Changsha, China
| | - Xin Hu
- Community Nursing Department, Xiangya Nursing School of Central South University, Changsha, China
| | - Huiwu Han
- Department of Cardiology, Xiangya Hospital of Central South University, Changsha, China
| | - Jing Su
- Department of Nursing, Shantou University Medical College, Shantou, China
| | - Emin Peng
- Outpatient Clinic, Xiangya Hospital of Central South University, Changsha, China
| | - James Wiley
- Institute for Health Policy Studies, University of California, San Francisco, CA, United States of America
| | - Lisa Lommel
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, United States of America
| | - Jyu-Lin Chen
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, United States of America
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Ma X, Yang X, Yin H, Wang Y, Tian Y, Long C, Bai C, Dong F, Wang Z, Liu T, Gu X. Stunting among kindergarten children in China in the context of COVID-19: A cross-sectional study. Front Pediatr 2022; 10:913722. [PMID: 35990001 PMCID: PMC9386711 DOI: 10.3389/fped.2022.913722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of COVID-19 has most likely increased the prevalence of stunting. The study aimed to determine the prevalence of stunting among kindergarten children in the context of coronavirus disease 2019 (COVID-19) in Longgang District, Shenzhen, China, and its risk factors. METHODS A cross-sectional study was conducted to identify children from 11 sub districts of 481 kindergartens in the Longgang District of Shenzhen City from May to July 2021. In the context of COVID-19, an online survey was conducted to gather demographic information, height, birth information, and lifestyle. The prevalence of stunting was calculated, and the risk factors were analyzed using binary logistic regression with three stepwise models. RESULTS A total of 118,404 subjects were included from May to July 2021, with a response and questionnaire effective rates of 85.75% and 95.03%, respectively. The prevalence of stunting and severe stunting were 3.3% and 0.8%, respectively. Model 3 showed that risk factors for stunting were male sex [odds ratio (OR) = 1.07], low birth weight (OR = 2.02), insufficient sleep time (OR = 1.08), less food intake than their peers (OR = 1.66), slower eating than their peers (OR = 1.16), accompanied by grandparents alone or non-lineal relatives (reference: parents accompanying) (OR = 1.23, 1.51), and children induced to eat (OR = 1.17). Protective factors included only-child status (OR = 0.66), reported high activity (OR = 0.37, 0.26, 0.23), parents with high education levels (father: OR = 0.87, 0.69; mother: OR = 0.69, 0.58), high monthly income per capita of the family (OR = 0.88, 0.74, 0.68), and allowing children to make food choices (OR = 0.82). CONCLUSION The stunting rate of children in kindergartens in Longgang District is 3.3%, close to the level of developed countries but higher than the average level of developed cities in China. The relatively high stunting rate in children under 3 years old in 2021 may be associated with the influence of COVID-19. Appropriate policies should be formulated for individuals and families with children to help children establish good living habits and reduce stunting.
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Affiliation(s)
- Xueyan Ma
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiangzheng Yang
- Department of Pediatrics, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, China
| | - Hongzhi Yin
- Department of Pediatrics, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, China
| | - Yang Wang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanshuo Tian
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chaojun Long
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Bai
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fei Dong
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zhendong Wang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Tiegang Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohong Gu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Wang J, Zhu J, Wang X, Che Y, Bai Y, Liu J. Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study. Int J Equity Health 2021; 20:250. [PMID: 34856984 PMCID: PMC8638552 DOI: 10.1186/s12939-021-01584-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Migrants account for a large part of China's population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China's Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China. METHODS This study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records. RESULTS The establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records. CONCLUSION There existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants' health literacy.
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Affiliation(s)
- Jun Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Jingmin Zhu
- Department of Economics, University of Birmingham, B15 2TT, Birmingham, UK
| | - Xueyao Wang
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Yue Che
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Yang Bai
- Center for Health Policy Research and Evaluation, Renmin University of China, Beijing, 100872 China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100080 China
- Institute for Global Health and Development, Peking University, Beijing, 100871 China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, 100083 China
- School of Public Health, Peking University; Institute for Global Health and Development, Peking University, Beijing, 100191 China
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25
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Arize I, Ogbuabor D, Mbachu C, Etiaba E, Uzochukwu B, Onwujekwe O. Stakeholders' Perspectives on the Unmet Needs and Health Priorities of the Urban Poor in South-East Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021:272684X211033441. [PMID: 34264139 DOI: 10.1177/0272684x211033441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders' perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor.
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Affiliation(s)
- Ifeyinwa Arize
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Daniel Ogbuabor
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.,Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria
| | - Enyi Etiaba
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.,Department of Community Medicine, Institute of Public Health, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria
| | - Obinna Onwujekwe
- Department of Health Administration and Management, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria Nsukka, Enugu Campus, Nigeria.,Health Policy Research Group, Department of Pharmacology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
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26
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Xie Y, Guo Q, Meng Y. The health service use of aged rural-to-urban migrant workers in different types of cities in China. BMC Health Serv Res 2021; 21:606. [PMID: 34182984 PMCID: PMC8237433 DOI: 10.1186/s12913-021-06638-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between different types of cities and the use of health services by aged migrant workers in China has not been widely reported in previous studies. This article aims to focus on rural-to-urban migrant workers in China aged 50 years and older to examine the relationship between the region of these migrant workers' destination city (eastern, central or western) and migration city type (first-tier, second-tier, third-tier and smaller cities) and their use of health services (e.g., establishing health records, participating in health education, and seeking medical treatment when ill). METHODS This study's data were obtained from China Migrants Dynamic Survey in 2017. A total of 14,732 rural-to-urban migrant workers aged 50 years and older were included in the analysis; 6,938 of the migrant workers were either ill or had recently experienced physical discomfort. A chi-square test and binary logistic regression were performed to explore the associations between these rural-urban migrants' destination cities and their use of health services. RESULTS This study found that aged rural migrant workers who moved to the east or to first- or second-tier cities were less likely to establish health records, participate in health education programme, and seek medical care. CONCLUSIONS Migrant destination cities are linked to the use of local health services by migrant workers aged 50 years and older in China. We found that aged migrant workers who migrated to relatively developed regions and cities accessed fewer health services. Such results signify that more attention should be paid to aged migrant workers' use of health services in economically developed regions and cities, to eliminate regional differences in healthcare inequality.
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Affiliation(s)
- Yating Xie
- Research Center for Social Governance Innovation, Henan Agricultural University, Zhengzhou, 450006, Henan, China
| | - Qiuju Guo
- Elder Service Research Center, School of Sociology, Huazhong University of Science and Technology, Luoyu Road #1037, Hubei, 430074, Wuhan, China.
| | - Yang Meng
- The Institute for Population and Development Studies, Xi'an Jiaotong University, 710049, Xi'an, Shaanxi, China
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27
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Qiao J, Wang Y, Li X, Jiang F, Zhang Y, Ma J, Song Y, Ma J, Fu W, Pang R, Zhu Z, Zhang J, Qian X, Wang L, Wu J, Chang HM, Leung PCK, Mao M, Ma D, Guo Y, Qiu J, Liu L, Wang H, Norman RJ, Lawn J, Black RE, Ronsmans C, Patton G, Zhu J, Song L, Hesketh T. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China. Lancet 2021; 397:2497-2536. [PMID: 34043953 DOI: 10.1016/s0140-6736(20)32708-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jie Qiao
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
| | - Yuanyuan Wang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, National Center for Birth Defect Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Fan Jiang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ma
- Institute of Child and Adolescent Health, Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing, China
| | - Jing Ma
- China Program for Health Innovation & Transformation, Department of Population Medicine, Harvard University, Boston, MA, USA
| | - Wei Fu
- China National Health and Development Research Centre, Beijing, China
| | - Ruyan Pang
- China Maternal and Child Health Association, Beijing, China
| | - Zhaofang Zhu
- China National Health and Development Research Centre, Beijing, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xu Qian
- School of Public Health & Global Health Institute, Fudan University, Shanghai, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiuling Wu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hsun-Ming Chang
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Peter C K Leung
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Meng Mao
- National Office for Maternal and Child Health Surveillance of China, National Center for Birth Defect Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Duan Ma
- Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, Fudan University, Shanghai, China
| | - Yan Guo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Jie Qiu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Li Liu
- Department of Population Family and Reproductive Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert J Norman
- Robinson Research Institute, Fertility SA, University of Adelaide, Adelaide, SA, Australia
| | - Joy Lawn
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert E Black
- Department of Population Family and Reproductive Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carine Ronsmans
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - George Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, National Center for Birth Defect Surveillance of China, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Li Song
- Department of Women and Children Health, National Health Commission of the People's Republic of China, Bejing, China.
| | - Therese Hesketh
- Center for Global Health, School of Medicine, Zhejiang University, Hangzhou, China; and Institute for Global Health, University College London, London, UK
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Residents' Willingness to Maintain Contracts with Family Doctors: a Cross-sectional Study in China. J Gen Intern Med 2021; 36:622-631. [PMID: 33140279 PMCID: PMC7947157 DOI: 10.1007/s11606-020-06306-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most previous studies of the family doctor contract services (FDCS) evaluated its quality by using residents' signing rates, awareness, and satisfaction. We hypothesize that renewal willingness could be another important indicator to examine the quality of FDCS. OBJECTIVE To measure residents' willingness to maintain contracts with family doctors and examine the influencing factors. DESIGN Cross-sectional study. PARTICIPANTS 11,250 residents in 31 provincial administrative regions across China. MAIN METHODS A multistage stratified random sampling method was used to recruit participants. Univariate analysis, mixed-effect regression model analysis, and stepwise multivariate logistic regression analysis were performed to determine the influencing factors of residents' willingness to maintain contracts with family doctors. KEY RESULTS About 71.3% participants who contracted with and received healthcare services from family doctors were willing to maintain contracts with family doctors in China. Residents registering as local households (OR = 1.192, 95% CI = 1.039-1.368), enrolled in medical insurance (OR = 1.299, 95% CI = 1.011-1.668), reporting better health (OR = 1.246, 95% CI = 1.100-1.413), with shorter walking time to the nearest healthcare center (compared with > 30 min walking time, < 15 min: OR = 1.209, 95% CI = 1.003-1.458; 15-30 min: OR = 1.288, 95% CI = 1.124-1.475), and trusting in (OR = 4.403, 95% CI = 3.849-5.036) and satisfied with (OR = 18.514, 95% CI = 16.195-21.165) their family doctors had significantly higher willingness to maintain contracts with family doctors. CONCLUSIONS Residents' willingness to maintain contracts with family doctors could be another evaluation indicator of the quality of FDCS in China. Improving the accessibility and quality of healthcare services from family doctors may increase residents' willingness to keep contracts with family doctors and promote the implementation of FDCS.
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Wang Y, Jing Z, Ding L, Tang X, Feng Y, Li J, Chen Z, Zhou C. Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China. BMC Health Serv Res 2020; 20:984. [PMID: 33109188 PMCID: PMC7590715 DOI: 10.1186/s12913-020-05843-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. METHODS The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level. RESULTS Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively. CONCLUSION This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.
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Affiliation(s)
- Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Zhengyue Jing
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Lulu Ding
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xue Tang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Yuejing Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, GA, 30606, USA.,School of Economics, University of Nottingham, Ningbo, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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30
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Xie J, Liao J, Zhang J, Gu J. Association between rural-to-urban migration and the cognitive aging trajectories of older Chinese adults: results from a prospective cohort analysis. BMC Geriatr 2020; 20:360. [PMID: 32957920 PMCID: PMC7507287 DOI: 10.1186/s12877-020-01772-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasingly, older Chinese adults from rural areas are moving to urban areas to live with their children who have already migrated to these areas. However, few studies have examined this pattern of migration and its effects on cognitive function. We aimed to investigate the association between domestic rural-to-urban migration and the trajectories of cognitive function in older Chinese adults, as well as the factors contributing to these association. METHODS Data for this study were drawn from three waves of the China Health and Retirement Longitudinal Study. Migrants were defined as participants who had rural hukou status (under China's household registration system) but resided in an urban area. Cognitive functions were measured using an adapted Chinese version of the Mini-Mental State Examination. We used multilevel linear regression models to examine the association between internal migration and cognitive function trajectories. RESULTS The study included 3876 Chinese adults aged ≥60 years at baseline. Compared with their rural non-migrant counterparts, migrants (n = 850) had higher levels of education and reported more interactions with family. Additionally, female migrants were more likely to participate in leisure activities. All cognitive function scores declined over time, but no significant differences were observed in rates of cognitive decline between migrants and non-migrants, regardless of sex. Female migrants exhibited significantly better performance in terms of total cognition (β = 0.77, P < .001) and mental status (β = 0.68, P < .001) than female non-migrants, whereas no inter-group difference was observed regarding memory (β = 0.09, P > .05). Among the male subjects, no significant differences in cognitive function levels were observed between migrants and non-migrants. A series of adjusted models revealed that psychosocial factors such as residing with children, caring for grandchildren, depression and participation in leisure activities partly explained the association between migration and cognition in women. CONCLUSIONS Rural-to-urban migration was positively associated with cognitive functions only in women. However, this pattern did not affect the rate of cognitive decline in either sex. Our findings provide directions for tailored interventions improving cognitive functions of older adults and rural non-migrating older adults, especially female non-migrants.
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Affiliation(s)
- Jinzhao Xie
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong, China
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong, China.,Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong, China
| | - Jing Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong, China. .,Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, 2nd Zhongshan Road, Guangzhou, Guangdong, China.
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31
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Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176327. [PMID: 32878066 PMCID: PMC7504160 DOI: 10.3390/ijerph17176327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06–1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30–1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%–5.8%) and 6.1 percentage point (95% CI: 4.3%–7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93–1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54–0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.
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Caraballo C, Khera R, Jones PG, Decker C, Schulz W, Spertus JA, Krumholz HM. Rates and Predictors of Patient Underreporting of Hospitalizations During Follow-Up After Acute Myocardial Infarction: An Assessment From the TRIUMPH Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006231. [PMID: 32552061 DOI: 10.1161/circoutcomes.119.006231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many clinical investigations depend on participant self-report as a principal method of identifying health care events. If self-report is used as the trigger to collect and adjudicate medical records, any event that is not reported by the patient will be missed by the investigators, reducing the power of the study and misrepresenting the risk of its participants. We sought to determine the rates and predictors of underreporting hospitalization events during the follow-up period of a prospective study of patients hospitalized with an acute myocardial infarction. METHODS AND RESULTS The TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) registry, a longitudinal multicenter cohort study of people with acute myocardial infarction in the United States, queried patients for hospitalization events during interviews at 1, 6, and 12 months. To validate these self-reports, medical records for all events at every hospital where the patient reported receiving care were acquired for adjudication, not just those for the reported events. Of the 4340 participants in TRIUMPH, 1209 (28%) reported at least one hospitalization. After medical records abstraction and adjudication, we identified 1086 hospitalizations from 639 participants (60.2±12 years of age, 38.2% women). Of these hospitalizations, 346 (31.9%) were underreported by the participants. Rates of underreporting ranged from 22.5% to 55.6% based on different patient characteristics. The odds of underreporting were highest for those not currently working (adjusted odds ratio, 1.66 [95% CI, 1.04-2.63]), lowest for those married (adjusted odds ratio, 0.50 [95% CI, 0.33-0.76]), and increased the longer the elapsed time between the admission and the patient's follow-up interview (adjusted odds ratio per month, 1.16 [95% CI, 1.08-1.24]). There was a substantial within-individual variation on the accuracy of reporting. CONCLUSIONS Hospitalizations after acute myocardial infarction are commonly underreported in interviews and should not be used alone to determine event rates in clinical studies.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (C.C., W.S., H.M.K.)
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO (P.G.J., C.D., J.A.S.)
| | - Carole Decker
- Saint Luke's Mid America Heart Institute, Kansas City, MO (P.G.J., C.D., J.A.S.)
| | - Wade Schulz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (C.C., W.S., H.M.K.).,Department of Laboratory Medicine (W.S.), Yale School of Medicine, New Haven, CT
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (P.G.J., C.D., J.A.S.).,Division of Cardiology, Department of Internal Medicine, University of Missouri-Kansas City (J.A.S.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (C.C., W.S., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Myerson R, Lu T, Yuan Y, Liu GGE. Cancer diagnosis and care among rural-to-urban migrants in China. BMJ Glob Health 2020; 4:e001923. [PMID: 31908866 PMCID: PMC6936538 DOI: 10.1136/bmjgh-2019-001923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Cancer is a leading cause of death in China. Rural-to-urban migrants are a group of over 260 million people in China sometimes termed the 'floating' population. This study assessed the prevalence of cancer diagnosis and access to needed healthcare by residence and migration status in China. Methods We used data from the China Health and Retirement Longitudinal Survey, a nationally representative population-based random sample of adults age 45 years and older and their spouses in China. We used multivariable logistic regressions to compare outcomes among rural-to-urban migrants, local urban residents and local rural residents after adjusting for province of residence, socioeconomic status and demographic characteristics. Results The sample included 7335 urban residents, 9286 rural residents and 3255 rural-to-urban migrants. Prevalence of cancer diagnosis was 9.9 per 1000 population among rural-to-urban migrants (95% CI 6.5 to 15.1 per 1000 population). Rural-to-urban migrants had higher tobacco use (OR=2.01; 95% CI 1.59 to 2.56, p<0.001), lower use of a health check-up (OR=0.57; 95% CI 0.48 to 0.67, p<0.001) and lower prevalence of diagnosed cancer (OR=0.41; 95% CI 0.18 to 0.95, p=0.037) than urban residents. Among participants with diagnosed cancer, residence and migration status were not predictive of foregoing needed healthcare, but were predictive of diagnosis with a screen-detectable tumour (ie, breast, colon, prostate or cervical cancer) (OR=0.17; 95% CI 0.05 to 0.63, p=0.007 for rural residents; OR=0.34; 95% CI 0.09 to 1.22, p=0.098 for rural-to-urban migrants, compared with urban residents). Conclusion Rapid and large migration is still a driving force transitioning China. Due to some remaining dual policy settings in favour of local residents, rural migrants tend to use lower primary care and preventive health check-ups in general, and diagnosis of screen-detectable tumours in particular, leading to potentially higher risk of missing early diagnosis of cancers. Closing gaps in diagnosis of screen-detectable tumours could increase treatment and improve cancer outcomes.
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Affiliation(s)
- Rebecca Myerson
- Population Health Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Tianyi Lu
- Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, California, USA
| | - Yong Yuan
- Global Health Economics and Outcomes Research, Bristol-Myers Squibb Co, New York City, New York, USA
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Hospitalization Services Utilization Between Permanent and Migrant Females in Underdeveloped Rural Regions and Contributing Factors-A Five-Time Data Collection and Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183419. [PMID: 31540046 PMCID: PMC6765839 DOI: 10.3390/ijerph16183419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022]
Abstract
The proportion of migrating females has increased, and more often, old females are left in rural regions. Resources are needed to provide suitable hospitalization service to females in underdeveloped rural regions. Using multi-stage hierarchical cluster random sampling method, nine towns from three counties were enrolled in five-time points between 2006 and 2014 in this study. The research subjects of this study were females age 15 and up. Data regarding the utilization of inpatient services were collected and analyzed. Complex sampling logistic regression was conducted to analyze influencing factors. This study reveals that for both permanent females and migrant females, the older their age, the higher their hospitalization rate. The utilization of hospitalization service for permanent females was associated with the occurrence of chronic diseases (adjusted Odds Ratio (aOR) = 5.402). In addition, permanent females suffering from chronic diseases were more likely to avoid hospitalization despite their doctor’s advice (aOR = 34.657) or leave the hospital early against medical advice (AMA) (aOR = 10.009). Interventions to combat chronic diseases and adjust compensation schemes for permanent females need to be provided.
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Primary Drivers of Willingness to Continue to Participate in Community-Based Health Screening for Chronic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091645. [PMID: 31083535 PMCID: PMC6539676 DOI: 10.3390/ijerph16091645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/23/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
Background: As the average age of the population continues to rise in the 21st century, chronic illnesses have become the most prominent threats to human health. Research has shown that early screenings for chronic diseases are an effective way of lowering incidence and mortality rates. However, low participation rates for health screening is one of the main challenges for preventive medicine. The objective of this study was to determine the primary drivers which: (1) first motivate people to participate in community-based health screening for chronic diseases; and (2) increase their willingness to continue to participate. Methods: A total of 440 individuals between 30 and 75 years of age were invited to undergo a health screening and then complete an interview questionnaire. Screenings and interviews were conducted in four regions in northern Taiwan. The questionnaire was separated into three sections, which explored sociodemographic differences, drivers of willingness to participate, and willingness to continue to participate respectively. Raw data was analyzed using the statistical software package SPSS (SPSS Inc., Chicago, IL, USA). Main Outcome Measures: Effects of sociodemographic factors on health screening participation rate, drivers of willingness to participate, and willingness to continue to participate. Results: Seventy-three percent of participants responded that they would be willing to continue to join in future health screenings. Notably, elderly people and married people were respectively more likely to participate in preventive health screening than were younger people and people who were single, divorced, separated, or widowed. Level of education was another key driver of willingness to participate in health screening for chronic diseases, as were the concern of relatives/friends and the provision of participation incentives. Discussion: Some of our findings, such as the key drivers of willingness to continue to participate in health screening that we identified, were different from findings of many previous studies conducted in other countries. The current study also found that a higher percentage of participants would be willing to join a similar health screening in the future if the service design is considered in advance and is well-implemented.
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Yi Y, Liao Y, Zheng L, Li M, Gu J, Hao C, Hao Y. Health Selectivity and Rural-Urban Migration in China: A Nationwide Multiple Cross-Sectional Study in 2012, 2014, 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091596. [PMID: 31067684 PMCID: PMC6540158 DOI: 10.3390/ijerph16091596] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 12/27/2022]
Abstract
Background: China is undergoing an unprecedented rural-urban migration, which may deeply influence the health of internal migrants. Previous studies suggested that migrants are a selectively healthier population. This paper examines the evidence for and the changes of health selectivity among Chinese internal migrants. Methods: We use data from the China Labor-force Dynamics Survey (CLDS), a nationally representative survey conducted in 2012, 2014, and 2016, respectively. The health statuses of four groups of research subjects (out-migrants, returned migrants, rural residents, and urban residents) are measured by general health, physical health, and emotional health. Results: By comparing the health status of migrants with that of rural residents, we find supportive evidence for the Healthy Migrant Hypothesis that migrants exhibit better health than rural residents in their hometown. We also add strength to the Salmon Bias Hypothesis that migrants returning to their hometowns are less healthy than those still being outside. However, migrants present worse emotional health in both comparisons. The general and physical health gaps between migrants, rural residents, and returnees widened in all three rounds of the survey, which implies a possibly increasing trend of health selectivity. This study also suggests that bringing family to the destination requires better general and physical health, but not emotional health. Conclusions: Migrants are positively selected on general and physical health. The health selectivity in 2012–2016 is highly likely to increase, which means that there are increasing number of obstacles for migrants to overcome. Family migration’s high requirement for health might also contribute to it. It is urgent to establish and improve primary health care service systems in rural areas in current circumstances.
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Affiliation(s)
- Yao Yi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
| | - Yu Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China.
| | - Lingling Zheng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
| | - Mengjie Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
| | - Chun Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
- Guangdong Key Laboratory of Health Informatics, Sun Yat-sen Global Health Institute, Sun Yat-sen University, 74 Zhong Shan 2nd Road, Guangzhou 510080, China.
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