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1.
Mao-Sheng Ran Xue Weng Yu-Jun Liu Tian-Ming Zhang Graham Thornicroft Larry Davidson Cheryl H.K. Chui Shi-Hui Hu Xin Yang Fu-Rong Lin Chang-Cheng Liu Bo Liu Eric Yu-Hai Chen Cecilia Lai-Wan Chan Wei-Hong Kuang Meng-Ze Xiang 《Lancet》2017
Background
Little is known about the change in long-term prevalence of mental disorders during a period of sustained rapid socioeconomic development. Here we explore the prevalence change of severe mental disorders in a 21-year longitudinal study in a rural area of China.Methods
Epidemiological surveys of mental disorders were done in May, 1994, and October, 2015, in six townships (total population 170?174 in 2015) in Xinjin County, Chengdu, China. Psychoses Screening Schedule (PSS) together with key informant method for household survey and general psychiatric interview were administered to identify the persons with severe mental disorders according to International Classification of Mental and Behavioural Disorders-10 (ICD-10) criteria.Findings
Among all persons aged 15 years and older, the age-standardised lifetime prevalence of all mental disorders increased 48·2% from 870·1 per 100?000 population (95% CI 811·3–928·9 per 100?000 population) in 1994 to 1289·4 per 100?000 population (1218·0–1360·8 per 100?000 population) in 2015. The age-standardised lifetime prevalence of schizophrenia was the highest among all mental disorders and remained relatively stable from 1994 (416·0 per 100?000 population) to 2015 (427·9 per 100?000 population). Between 1994 and 2015, the age-standardised lifetime prevalence increased for affective disorders (41%), alcohol dependence and alcoholism (373·8%), drug and substance abuse (1809%), and mental disorder plus cerebrovascular disease (214%), brain trauma (388%), and senile dementia (126%). Moreover, age-standardised lifetime prevalence was significantly higher in men (1465·5 per 100?000 population) than in women (1179·0 per 100?000) in 2015 (p<0·0001).Interpretation
Various mental disorders in people living in the rural community display different trends from 1994 to 2015. Although the age-standardised lifetime prevalence of all causes disorders increased from 1994 to 2015, the prevalence of schizophrenia remained relatively stable. Prevalence of affective disorders, alcohol dependence and alcoholism, drug and substance abuse, senile dementia, and other organic disorders increased sharply, possibly indicating the effect of socioeconomic development on mental disorders. Mental health policy and services should be improved and adjusted according to the prevalence change of mental disorders. The limitations of this study include: (1) the sample investigated was from one rural area of China; (2) only two surveys were done; and (3) as many young people in this rural area might move to work temporarily in urban areas, the final reported prevalence might underestimate the true prevalence in young people.Funding
The investigation in 1994 was supported in part by the China Medical Board of New York (CMB, 92-557, to MZX). The investigation in 2015 was supported in part by Seed Funding Programme for Basic Research (HKU, 2014-2016, to MSR), Seed Funding Programme for Applied Research (HKU, 2014-2016, to MSR), Strategic Research Theme (SRT): Contemporary China Seed Funding (HKU, 2014-2016, to MSR), Small Project Funding (HKU, 2014-2016, to CLWC), and Mental Health Research in Chengdu, China (Dept. Matching Fund, 2015-2017, to MSR). 相似文献2.
3.
Background
The burden of non-communicable diseases burden in China is enormous, with tobacco consumption a leading risk factor for the most prevalent NCDs. Therefore, understanding pattern of socioeconomic equalities of tobacco consumption will help to design targeted public health control measures. We aimed to investigate who tends to consume most tobacco in China.Methods
Nationally representative data from the 2013 China Health and Retirement Longitudinal Study (CHARLS) included smoking information on 17?663 respondents aged 45 years and older. Smoking prevalence and smoking quantities were defined to capture tobacco consumption. Using concentration index (defined as twice the area between the concentration curve and the line of equality), we estimated income-related inequality of tobacco consumption grouped by gender. The inequality of tobacco consumption was further decomposed into each determinant's specific contribution on using probit regression analysis and Ordinary Least Squares (OLS) regression models.Findings
About 16·03% of respondents consumed tobacco. By sex, 8449 men (29·65%) and 9213 women (3·54%) consumed tobacco. Furthermore, we found a significant pro-rich inequality of tobacco consumption. The concentration index of smoking incidence was 0·0438 (0·0412 for men; ?0·0393 for women). The concentration index of smoking quantities among people who smoke was 0·0385 (0·0333 for men; 0·0381 for women), whereas the concentration index of smoking quantities in the whole population was 0·0748 (0·0675 for men; ?0·0044 for women). Most of the inequality can be explained by education attainments, age, geographical areas, and economic status.Interpretation
Sex, education attainments, age, geographical areas, and economic status were strong predictors of tobacco consumption in China. Public health policies need to be targeted towards the less educated people and elderly people. Both the pattern and magnitude of inequality varied greatly between men and women, and public policies for tobacco control in men should be strengthened at southern-central and northern areas of China, whereas public policies for women should be strengthened in the eastern and northeastern areas of China.Funding
Research Program of Shaanxi Soft Science (2015KRM117), Shaanxi Provincial Youth Star of Science and Technology in 2016, Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), and National Program for Support of Top-notch Young Professionals and China Medical Board (15-227). 相似文献4.
Background
With the rapid pace of population ageing, tuberculosis in older people has become a public health challenge in China. However, the age-structured epidemiological transition and its impact on achieving the end tuberculosis targets by 2035 have not been understood well. We analysed the age-structured incidence and mortality of pulmonary tuberculosis reported in China to inform current and future control programmes.Methods
In this longitudinal study, we compared the trends of age-specific reported incidence and mortality of pulmonary tuberculosis from 2005 to 2015 in China. In addition to crude rates, we calculated age-adjusted rates from 2006 to 2015 by taking the population in 2005 as reference. We determined the annual crude and age-adjusted rates of reduction by fitting an exponential linear regression model, and extrapolated up to 2035 given fixed decline rates. All data were collected from national Infectious Disease Reporting System and Diseases Surveillance System.Findings
We noted overall downward trends of reported tuberculosis incidence and mortality in all age and sex groups since 2005, whereas the proportion of older people (aged 65 years and older) among reported patients with tuberculosis and deaths increased gradually. The total tuberculosis incidence and mortality were significantly higher in older people (193·0 cases per 100?000 people and 18·7 deaths per 100?000 people, respectively) than in younger groups (66·6 cases per 100?000 and 1·7 deaths per 100?000 people). The average annual decline in crude incidence was 4·2% (95% CI 3·5–4·9) and 5·1% (4·3–5·9%) in age-adjusted incidence; the annual decline in crude mortality was 9·7% (95% CI 8·4–10·9) and 12·4% (10·9–13·8) in age-adjusted mortality. Extrapolating this trend, by 2035, the crude incidence of tuberculosis was expected to reach 26·8 cases per 100?000 people and the age-adjusted incidence to reach 20·6 cases per 100?000 people, which would result in a total reduction of 57·8% and 65·0%, respectively, compared with the rates in 2015. By 2035, the crude mortality was expected to reach 0·33 deaths per 100?000 people and the age-adjusted mortality to reach 0·15 deaths per 100?000 people, which would result in a total reduction of 86·0% and 92·0%, respectively, compared with the rates in 2015.Interpretation
These findings demonstrated an age transition of tuberculosis epidemic and the effects of population ageing on slowing down tuberculosis control progress made in China. An average 6–7% reduction would be cancelled out by 2035 given current tuberculosis decline trend and demographic change. An enhanced surveillance with age-sensitive analysis of patients with tuberculosis and a targeted response are needed.Funding
None. 相似文献5.
Background
Long-acting injectable (LAI) antipsychotics have been shown to reduce risk of relapse in people with psychosis. Second generation LAI antipsychotics such as paliperidone palmitate can have fewer side-effects and be better tolerated than first generation LAI antipsychotics. However, paliperidone palmitate is more expensive and there are few data comparing its effectiveness and tolerability with that of other LAI antipsychotics. We sought to address this issue by analysing a large electronic mental health case register.Methods
The South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register was used to obtain data about people who had started treatment with an LAI antipsychotic between April 1, 2011, and Jan 31, 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analysed using multivariable regression with age, sex, ethnicity, marital status, diagnosis, and London borough of residence as covariates.Findings
1281 people had started treatment with LAI antipsychotics. The most frequently prescribed LAI was paliperidone palmitate (n=430, 33·6%) followed by zuclopenthixol decanoate (226, 17·6%), flupentixol decanoate (203, 15·9%), risperidone (160, 12·5%), pipotiazine palmitate (114, 8·9%), haloperidol (71, 5·5%), fluphenazine decanoate (36, 2·8%), aripiprazole (27, 2·1%), and olanzapine embonate (14, 1·1%). There were no significant differences between paliperidone and other LAI antipsychotics in the number of days as an inpatient (β coefficient 5·4 days, 95% CI ?57·3 to 68·2) or number of hospital admissions after initiation of treatment (incidence rate ratio 1·07, 95% CI 0·62 to 1·83).Interpretation
The absence of differences in hospital admission after initiation of LAI antipsychotics indicates that the effectiveness of the second generation LAI paliperidone palmitate was similar to that of other LAI antipsychotics. However, the discontinuation rate in the first year of treatment is lower for paliperidone palmitate (35%) than for other LAI antipsychotics suggesting that it is better tolerated. These findings merit consideration in relation to the choice of LAI antipsychotic to prescribe in people with psychotic disorders.Funding
National Institute for Health Research, Medical Research Council. 相似文献6.
Background
Adolescent mental health is poor in the UK, with higher prevalence of poor mental health in adolescents living in poverty. However, little experimental evidence exists to understand the potential impact of poverty reduction on inequalities in mental health in the UK population. We aimed to fill this gap by assessing the effect of poverty reduction with a hypothetical intervention on adolescent mental health.Methods
We simulated the effect on inequalities in adolescent mental health of a hypothetical intervention that lifts all families with children out of poverty, using a population-representative sample of 11?564 adolescents followed up to age 14 years in the UK Millennium Cohort Study (MCS). Our measure of socioeconomic conditions (SECs) at birth was maternal education dichotomised as low (GCSE all grades D–G or lower, or no qualifications) versus high (GCSE grades A–C, or above). Our outcome was socioemotional behaviour problems (yes or no) as measured by parent-rated Strength and Difficulties Questionnaire total difficulty score of ≥17. We estimated the controlled direct effect, and proportion eliminated, of SECs on mental health after blocking the mediating pathway, of ever being exposed to poverty (<60% of median of equivalised household income) in all six MCS waves; we used marginal structural models with stabilised inverse probability weights accounting for confounding (exposure–mediator and mediator–outcome). Multiple imputation was used to handle missing data.Findings
4105 (35%) of 11?564 of the families were ever exposed to poverty in at least one MCS wave. Compared with adolescents from high SEC families, those from low SEC families had increased risk of socioemotional behaviour problems at age 14 years (relative risk 1·97, 95% CI 1·64–2·37]. When all families were hypothetically lifted out of poverty, the risk of socioemotional behaviour problems at age 14 years was reduced substantially (1·07, 1·03–1·11, proportion eliminated 93%). Our results appear robust in the presence of moderate unmeasured confounding by unknown confounders.Interpretation
Social inequalities in adolescent mental health in the UK could be substantially reduced by lifting families out of poverty. Limitations include the self-reported income measure in the MCS and the assumption of no unmeasured confounding that is required for causal interpretation.Funding
Funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1) (for DT-R and ETCL). 相似文献7.
Marie Jonassen Amira Shaheen Mohammed Duraidi Khaled Qalalwa Bernard Jeune Henrik Brønnum-Hansen 《Lancet》2018
Background
People living in the occupied Palestinian territory have high levels of poverty and unemployment and low educational level. The aim of this study was to investigate the association between socioeconomic status and self-reported chronic disease and to determine whether this association differed between Palestinians living in and outside refugee camps.Methods
The study was based on representative samples of Palestinians living in the occupied Palestinian territory (West Bank and Gaza Strip), aged 25 years and older, collected by the Palestinian Central Bureau of Statistics in 2006 and 2010. Educational level, wealth, and employment status were used as measures of socioeconomic status. Participants reporting a diagnosis and treatment for at least one chronic disease were categorised as having a chronic disease. We used logistic regression models to estimate the association between socioeconomic status and chronic disease and to compare the prevalence of chronic disease between Palestinians living in or outside refugee camps adjusted by socioeconomic status.Findings
The sample included 38?888 participants. Associations between all measures of socioeconomic status and chronic disease were highly significant. In 2010, the odds ratio (OR) of reported chronic disease in illiterate men and women were 1·37 (95% CI 1·21–1·56) and 1·45 (1·29–1·63), respectively, compared with men and women with elementary or preparatory educational levels. Compared with the richest quintile, the OR in the poorest quintile was 1·70 (1·47–1·96) for men and 1·80 (1·56–2·07) for women. Compared with employed people, the OR in unemployed people was 1·50 (1·31–1·71) for men and 1·12 (0·76–1·65) for women. Similar results were found for 2006. The prevalence of chronic disease was substantially higher in Palestinians living in refugee camps (29%) than in those living outside refugee camps (24%). The associations between socioeconomic status and chronic disease did not differ between people living in or outside refugee camps.Interpretation
We found highly significant associations between socioeconomic status and self-reported chronic disease. Although the prevalence of chronic disease was highest in Palestinians living in refugee camps, the pattern of association between socioeconomic status and chronic disease did not differ between Palestinians living in and outside refugee camps.Funding
None. 相似文献8.
Eithne Sexton Nora Donnelly Martin O&#x;Flaherty Maria Guzman-Castillo Niamh Merriman Anne Hickey Maev-Ann Wren Kathleen Bennett 《Lancet》2018
Background
Post-stroke cognitive impairment (PSCI) is a common consequence of stroke, leading to reduced quality of life and increased care needs. However, cognitive impairment receives less attention in stroke rehabilitation relative to physical disability. We aimed to apply estimates of PSCI incidence to the Irish population and project the number of patients who could potentially benefit from cognitive rehabilitation.Methods
We developed the StrokeCog deterministic model to estimate incidence of PSCI in the population aged 40–89 years living in Ireland in 2015, and project cumulative incidence in this cohort over 10 years. Population data, estimates, and projections to 2025 were obtained from the Central Statistics Office. Age-specific and sex-specific stroke incidence was estimated with 2015 stroke hospital discharge data (n=6155). Transition probabilities across five health states defined by cognitive impairment, physical disability, and dementia were estimated with data from participants reporting stroke in the English Longitudinal Study on Ageing (n=523). An annual stroke recurrence risk of 5% was assumed.Findings
Projections show that the Irish population aged 40–89 years in 2015 (2·05 million) will have a cumulative incidence of stroke of 3·7% by 2025 (74??948), of whom 19?082 (25·5%) will die from stroke and 20?580 (27·5%) from another cause. Of 35?287 survivors, 17?614 (49%) are predicted to have cognitive impairment without dementia, and 8677 (24·6%) to have dementia.Interpretation
In 2025, three quarters of Irish people who have survived a stroke in the preceding 10 years will have cognitive impairment and could potentially have benefited from cognitive rehabilitation. The model will be developed further to project yearly incidence and prevalence of PSCI in the Irish population to 2046, and to include a probabilistic sensitivity analysis to allow for uncertainty in any estimates; it will also be used to evaluate cost-effectiveness of cognitive rehabilitation. The model could also be adapted for use with UK populations.Funding
Health Research Board in Ireland (grant number ICE-2015-1048 and award RL-15-1579). 相似文献9.
Background
Neuropsychiatric conditions have become the leading cause of disability in adolescents aged 11–24 globally. Higher neighbourhood economic status was found to be associated with lower incidence of neuropsychiatric conditions in children and adolescents in developed countries, but there is a lack of evidence in China. This study aims to examine the associations between neighbourhood poverty and psychological distress among adolescents in China.Methods
We applied multilevel logistic regression to data from the 2014 China Family Panel Studies. 281 villages and 226 cities were randomly selected, and 1790 adolescents aged 11–15 were surveyed from 2178 households selected randomly. Severe psychological distress was defined as a score of 16 or over out of 24 in the K6 psychological disorder scale. Neighbourhood economic status was measured in two ways: using the log of median household monthly income within the community; and the percentage of residents receiving governmental subsistence allowance. Neighbourhood poverty was defined as more than 15% of residents receiving governmental subsistence allowance. We controlled for family-level economic conditions by ranking the households within each community by income. We also controlled for family structure and individual demographics. Rural and urban neighbourhoods were analysed separately.Findings
Of the surveyed adolescents, 2·3% (41 of 1790) were at high risk of severe distress (a score of >16 out of 24). The percentages were substantially higher in villages (2·6%, 29 of 1107) than in cities (1·8%, 12 of 683). Multilevel regression demonstrated diverse risk factors of psychological distress between adolescents in rural and urban areas. In villages, neighbourhood poverty was a significant and positive predictor of psychological distress in adolescents (adjusted odds ratio [AOR] 3·54, 95% CI 1·05–11·88, p=0·04), net of family-level and individual-level features. In cities, neighbourhood poverty had no significant effect on adolescents' mental health, but adolescents in families with higher income rankings within the community had a lower risk of psychological distress (0·81, 0·67–0·97, p=0·02). Median neighbourhood income and total household income were insignificant to adolescents' psychological distress in both rural and urban China.Interpretation
Our findings highlight the serious issue of psychological distress in adolescents, and its influencing factors, in rural and urban China. The study focused on neighbourhood poverty. Further studies may consider other ecological characteristics.Funding
No funding. 相似文献10.
Background
Depression is an important mental health disorder, which is facing a serious problem of inequality. However, compared with the field of physical health, there is not as much research into the fairness of mental health. Moreover, the research mainly focuses on cross-sectional studies. Vertical comparison is missing. Therefore, we aimed to measure the income-related inequality of depressive symptoms and its trends among elderly people in China.Methods
We extracted data from the 2011 baseline and 2015 follow-up of the China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative survey for elderly people aged 45 years and more in China. Depressive symptoms were evaluated with the Chinese version of the ten-item Center for Epidemiologic Studies-Depression Scale (CES-D). Participants were considered to have depressive symptoms once the CES-D score was 10 or more. We used five relative income levels derived from ratios between the participants' annual per capita household expenditure (PCE), excluding medical expenditure, and the median PCE of their cities. The concentration curve and index were used to measure and compare the magnitude of income-related inequality of depressive symptoms between 2011 and 2015. A logistic regression model was used to explore the crux of the inequality issue. Several confounding factors were controlled for in this model, including age, sex, marital status, and educational level.Findings
The prevalence of depression among the elderly in China decreased from 37·0% (5540 of 14?956 participants) in 2011 to 32·7% (5606 of 17?165) in 2015. However, the absolute value of the standardised concentration index increased from 0·005 in 2011 to 0·028 in 2015. The prevalence of depression in the lowest-income group had the weakest improvement of 2·4% points compared with the other four groups. In the logistic regression model, being a part of the population with the lowest income level in 2015 was a significant risk factor for depression compared with the other income groups.Interpretation
The prevalence of depression in people aged 45 years and more in China is declining, but the issue of income-related inequality has been exacerbated. The lowest-income group is the main factor contributing to the inequality. Policy analysis pointed out that China's current policy on equalisation of public health services has not specifically mentioned the issue of mental health. However, under the requirement of the Healthy China strategy, the fairness of mental health deserves attention.Funding
None. 相似文献11.
Background
General practitioners have an important role in primary health care, and the number of general practitioners can to some extent represent the quality of primary health care. This study aimed to quantify changes in the general practitioner workforce in China after recent health-care reforms, and assess the equity of general practitioner allocation in terms of geography and population.Methods
We adopted the method of literature review to obtain relevant historical data from official statistical bulletins and publications. We analysed the equity of general practitioners' allocation in China, from the aspects of geography (east, central, and western regions) and resident population.Findings
From 2012 to 2015, the total population of China increased by 1·52%. The number of general practitioners increased from 109?794 to 188?649, with an average annual growth of 19·77%. Meanwhile, the number of general practitioners per 10?000 population increased from 0·81 to 1·37. General practitioners accounted for 4·20% of doctors in 2012, increasing to 6·21% in 2015. The population density in east, central, and western China in 2015 was 526·23, 254·95, and 54·44 per km2, respectively, while the numbers of general practitioners per 10?000 population in each area were 1·83, 1·05, and 1·06. The density of general practitioners per 10?000 km2 was 614·08 in east China, 131·41 in central China, and 30·77 in western China in 2012, increasing to 961·94, 268·51, and 57·03, respectively, in 2015.Interpretation
Inadequate numbers and inequitable distribution of general practitioners represents one of the most obvious problems in primary health-care resourcing in China. Eastern China has been relatively successful in developing and increasing its general practitioner workforce since 2012. By contrast, the number of general practitioners per 10?000 population in central China has run at a lower level.Funding
National Nature Science Foundation of China (#71503170; for data interpretation), Shanghai Municipal Commission of Health and Family Planning (#201440036; for data collection), Pudong New Area Health and Family Planning Commission (#PW2016A-4; for data analysis). 相似文献12.
Background
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides health, education, and housing services to Palestinian refugees in Lebanon (PRL), and food assistance and welfare support to the most vulnerable refugees. Palestinian refugees recently displaced from Syria (PRS) to Lebanon have placed additional pressures on health and education services, and employment rights of Palestinians remain limited. The objective of this study was to provide an updated profile of the socioeconomic and health status of PRL and PRS after their influx into Lebanon.Methods
This nationally representative, multistage, cluster randomised survey of PRL and PRS households was done in April, 2015. Modules on socioeconomic, demographic, health, and food security variables were included. The poverty lines were US$6·84 per person per day for PRL households and $2·47 per person per day for PRS households. Food insecurity was assessed using the Arab Family Food Security Scale. Health conditions were reported for all household members by a household proxy. We used STATA version 13.0 to construct multivariate models to investigate independent predictors of poverty, food insecurity, and chronic disease. The study was approved by the Institutional Review Board of the American University of Beirut.Findings
2974 (88%) of the 3382 eligible PRL and 1050 (89%) of 1171 eligible PRS households gave informed consent and completed the questionnaire. 65% of PRL and 89% of PRS lived under the poverty line, whereas 3% of PRL and 9% of PRS were extremely poor. 62% of PRL and 95% of PRS were food insecure. Household size, unemployment, and low educational attainment of the head of household were associated with both poverty and food insecurity in PRL and PRS households. The prevalence of chronic illness was high in PRL and PRS households, with chronic disease in PRL households reported for 40% of people aged 19–59 years and for 88% of elderly adults (aged >60 years), and chronic disease in PRS households reported for 41% of people aged 19–59 years and for 86% of elderly adults. Chronic illness was independently associated with education and employment, household size, food insecurity, and area of residence.Interpretation
Palestinian refugees in Lebanon and those recently displaced from Syria to Lebanon are susceptible to poverty, food insecurity, and chronic illnesses, which vary with similar sociodemographic markers (mainly employment and education). Advocacy is needed to increase employment rights and ensure continued access to education and health services for Palestinians living in Lebanon, particularly with pressures on services resulting from the Syrian crisis.Funding
UNWRA. 相似文献13.
Background
Mental ill-health is very common among people in prison. However, although mental wellbeing features high in health and justice policies, it has been little studied in this population. This study aimed to address this gap using a routine survey of people in prison in Scotland.Methods
The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is a validated self-report measure of wellbeing scored from 14 (lowest wellbeing) to 70 (highest wellbeing). Since 2013, WEMWBS has been included in the Scottish Prisoner Survey, a biennial self-completed survey distributed to all people in custody in Scotland in paper format. We analysed data from survey sweeps from 2013, 2015, and 2017, using Student's t test to assess differences in mean WEMWBS score by sex and custodial status (sentenced or on remand) and ANOVA for age group. Comparisons with the population in private households were made using Scottish Health Survey data, stratified by age, sex, and deprivation quintile.Findings
WEMWBS data were available for 3158 of 6895 individuals in 2013 (46% of Scottish prison population), 2892 of 6915 in 2015 (42%), and 2405 of 6837 in 2017 (35%). Mean WEMWBS scores for the total sample were 43·4 in 2013 (SD 12·3), 41·8 (12·0) in 2015, and 41·2 (12·3) in 2017. People on remand had lower mean scores than did people sentenced (38·9 [SD 11·9] vs 44·5 [12·1] in 2013, 38·9 [11·3] vs 42·5 [12·1] in 2015, and 37·4 [12·0] vs 42·2 [12·1] in 2017; all p<0·001). There was little difference by sex except in 2013, when mean scores were higher in male than in female prisoners (43·6 [12·2] vs 41·5 [11·8], p=0·029). In all sweeps, mean scores were significantly lower among people in prison than in their peers of the same age group and sex in the most deprived quintile of the general population, except among those aged 50 years or older.Interpretation
This is the first reported study of mental wellbeing in a national prisoner population to our knowledge. Mental wellbeing among prisoners is significantly lower than in the general population, even after accounting for age, sex, and socioeconomic deprivation, and is particularly low among those on remand. These results contribute to a more holistic understanding of prisoner health and provide a baseline for monitoring changes in wellbeing in response to interventions.Funding
This work was funded through a Chief Scientist Office Clinical Academic Fellowship (CAF/17/11) held by EJT and by the Medical Research Councilgrants MC_UU_12017/13 and MC_UU_12017/15, and Chief Scientist Office grants SPHSU13 and SPHSU15. Information Services Division, NHS National Services Division Scotland employs LG and XG and provided in-kind support. 相似文献14.
Background
There is an increasing amount of data over the effect of folic acid and B vitamins (vitamin B6 and B12) on cardiovascular disease, but whether supplementation with folic acid and B vitamins can reduce the risk of cardiovascular disease among middle-aged and elderly patients remains unclear. We conducted this meta-analysis to assess the efficacy of folic acid supplementation in the prevention of cardiovascular disease.Methods
We searched PubMed and Web of Science for randomised controlled trials published between Jan 1, 1980, and Sept 1, 2015. We used relative risk (RR) with 95% CIs as a measure of effect of folic acid supplementation on the risk of cardiovascular disease. Data were independently extracted and sorted by two investigators to assess their quality. The results were pooled with a randomised-effects model using Stata 12.0 software. We used forest plots to analyse the effect of B vitamins as well as folic acid.Findings
We included 22 randomised controlled trials reporting data on 79?564 participants. All participants were aged 45 years or older (ie, middle-aged or elderly). Supplementation with both folic acid and B vitamins together was not associated with any significant reduction in the risk of cardiovascular events (RR 0·98, 95% CI 0·92 to 1·03, p=0·353), myocardial infarction (1·00, 0·93 to 1·08, p=0·940), or total mortality (1·00, 0·94 to 1·06, p=0·778). However, a beneficial effect was observed for stroke, with supplementation with folic acid and B vitamins reducing the risk by 12% (RR 0·88, 95% CI 0·80 to 0·97, p=0·001). Moreover, we found that folic acid only could reduce the risk of cardiovascular events by 11% (RR 0·89, 95% CI 0·80 to 0·98, p=0·016) and the risk of stroke by 20% (0·80, 0·69 to 0·93, p=0·003). The level of homocysteine was reduced by 0·72 μmol/L (95% CI ?1·00 to ?0·44, p<0·0001).Interpretation
Supplementation with folic acid with or without B vitamins is more beneficial for stroke than for other cardiovascular outcomes in middle-aged and elderly patients.Funding
2012 Chinese Nutrition Society Nutrition Research Foundation—DSM Research Fund (2014-014); the Research Program of Shaanxi Soft Science (2015KRM117); the National High-Level Talents Special Support Plan (“Thousands of People Plan”); Shaanxi Provincial Youth Star of Science and Technology in 2016; and the Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007). 相似文献15.
Background
China has made remarkable efforts and achievements since its health reform in 2009, yet there are substantial knowledge gaps in the quality of primary health care (PHC) in China. We aimed to assess the quality of PHC in China by analysing hospital admission rates among diabetics, a frequently used quality indicator for PHC.Methods
We obtained data from a nationwide longitudinal survey for 1006, 1472, and 1771 participants with diabetes who were surveyed as part of China Health and Retirement Longitudinal Study in 2011, 2013, and 2015, respectively. We described and analysed primary care coverage and hospital admission rates (proportion of patients with diabetes who were admitted to hospital) to assess the quality of PHC in eastern, central, and western China. Primary care coverage included proportion of patients who received diabetes-related health education, examinations, and treatments. We used logistic regressions to model the changes of primary care coverage and hospital admission rates in 2011–15 by adjusting for sociodemographic variables. Ethical approval is not applicable in this study as we use anonymised secondary data.Findings
Health education coverage decreased significantly in 2011–15 (76·17% in 2011, 73·15% in 2013, and 70·15% in 2015; OR 0·747 [95% CI 0·62–0·90]) whereas the proportion of patients who received diabetic-related examinations and medical treatments remained largely unchanged (78·88% in 2011, 78·35% in 2013, and 81·45% in 2015; OR 1·18 [95% CI 0·95–1·45]). Moreover, the proportion of patients who received diabetic-related examinations in the west was lower than that in the east (OR 0·52 [0·35–0·76]). Diabetes-related hospital admission rates increased from 4·01% in 2011 to 6·08% in 2013 (OR 1·47 [0·97–2·22]), and recurrent hospital admission rates increased from 18·87% in 2011 to 28·45% in 2015 (OR 1·78 [1·44–2·20]). Both diabetes-related admission rates (OR 1·80 [1·13–2·87]) and recurrent hospital admission rates (OR 1·92 [1·50–2·45]) were higher in the west than in the east.Interpretation
Judging by the patient-reported process and outcome indicators studied, quality of PHC has not improved in China between 2011–2015. Continuous evidence-based monitoring, evaluation and reporting of PHC quality are crucial for accomplishing the goals of health-care system reform in China.16.
Background
Increasing concerns have arisen about provider misbehaviour in the Chinese health system, such as unnecessary care, with the potential consequence of an increase of health-care expenditure. This study aims to investigate the effect of medical information on health-care utilisation and expenditure in China based on the supplier-induced demand hypothesis.Methods
Data were derived from the China Labour-force Dynamics Survey (CLDS) done in 2014 using a multistage stratified cluster-random sampling method in 29 provinces in China. Providing information about health-care provision to some patients but not others, we identified 806 informed patients and 22?788 uninformed patients as our analytical sample. Using the coarsened exact matching method to control for confounding factors, we identified the impact of health-care information provision in China on proportion of patients who were outpatients and expenditure in the past 2 weeks as well as proportion of patients who were inpatients and expenditure in the past year. All study procedures were approved by the Health Science Center Ethics Committee at Xi'an Jiaotong University, Shaanxi, China (approval number: 2015-644) and all patients gave written informed consent.Findings
After coarsened exact matching, although the outpatient rate of uninformed patients seemed to be 0·6% higher than that of informed patients (4·3% [95% CI 3·9–4·8] vs 3·7% [2·3–5·1]), and the inpatient rate of uninformed patients seemed to be 1·1% lower than that of informed patients (4·3% [3·7–4·6] vs 5·3% [3·6–6·9]), none of these effects were significant. Uninformed patients paid 680 CNY more per outpatient visit than did informed patients (1126 CNY [95% CI 885–1368] vs 446 CNY [248–643]), accounting for 56·7% of the average outpatient expenditure of uninformed patients. However, uninformed patients paid 2061 CNY less per inpatient visit than informed patients did (15?584 CNY [9% CI 12 052–19?115] vs 17?645 CNY [488430 406]).Interpretation
The medical information has limited effect on outpatient and inpatient health-care utilisation in the health-care market in China. However, our results highlight the need for policies to address the large outpatient care expenses attributable to medical information asymmetry in the health-care market in China. Creating incentives for providers to provide less health-care services that could be avoided in the process of outpatient services may work well to reduce health-care costs, improve the governance of public hospitals, and institute a stronger regulatory system.Funding
China Medical Board (15–277), Research Program of Shaanxi Soft Science (2015KRM117), the National high-level talents special support plan (thousands of people plan), Shaanxi provincial youth star of science and technology in 2016 and the Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), China Scholarship Council (201706280307 and 201806280021), the US PEPPER Center Scholar Award (P30AG021342), National Institutes of Health/National Institute on Aging (R03AG048920 and K01AG053408). 相似文献17.
Background
Since the outbreak of HIV/AIDS caused by blood selling in Henan province in 2003, the Chinese government has adjusted the CD4 threshold for antiretroviral therapy (ART) several times to promote early treatment. However, the length of time between diagnosis and initiation of ART in China is unclear. This study aims to analyse the interval between HIV diagnosis and initial ART for patients infected with HIV/AIDS from 2004 to 2016.Methods
This retrospective study used hospital electronic health records data and a case report database for AIDS prevention and control in Yunnan province. We measured the time delay in months between diagnosis with HIV/AIDS and initial ART treatment. Differences in time intervals among different groups were studied with the Mann-Whitney U test and Kruskal-Wallis test. Multiple regression models were used to examine associated factors including the change of ART threshold in China.Findings
16957 people with HIV/AIDS infection were included in the study; the average age was 40 years (SD 13·34). The interval was longer than 6 months for 22·4% of homosexual people, 32·1% of heterosexual people, and 62·8% of drug users. The proportion of people who delayed treatment more than 6 months dropped from 93·8% in 2004 to 1·6% in 2016. The median time interval decreased from 59·2 months (SD 37·7) in 2004 to 0·5 months (SD 5·4) in 2016. Multiple regression analysis showed that the time between diagnosis and initiation of antiretroviral therapy differed significantly according to age, marital status, education level, group of people (heterosexual people, people who inject drugs, and homosexual people), and year of diagnosis (p<0·05).Interpretation
The interval between diagnosis and initial ART treatment among people with HIV/AIDS was substantially shorter in 2016 than in 2004. However, demographic differences in time to treatment exist among these people. Strategies to reduce time to treatment, especially for people using drugs and people with little education, are urgently needed.Funding
This study was supported in part by grants from the National Natural Science Foundation of China (project 71874100) and International Science and technology cooperation project of Tsinghua University (project 20163000254). 相似文献18.
Junjie Huang Jason LW Huang Mellissa Withers Kuo-Liong Chien Indang Trihandini Edmar Elcarte Vincent Chung Martin CS Wong 《Lancet》2018
Background
The prevalence of metabolic syndrome is growing because of increasing rates of obesity and sedentary lifestyle. Metabolic syndrome is one of the most important risk factors associated with diabetes, cardiovascular disease, and all-cause mortality. Few studies have examined its sex-specific prevalence in China across time. We compared the prevalences and temporal trends of metabolic syndrome in Chinese women and men.Methods
We conducted a PRISMA-compliant search in MEDLINE and Embase from their inception to Feb 15, 2018, for epidemiological studies that reported metabolic syndrome prevalence in Chinese individuals. We included data from population-based studies for individuals aged 15 years and older and a random effect model was used to estimate prevalence and 95% CI. We modelled within-study variability by binomial distribution and Freeman-Tukey double arcsine transformation to stabilise the variances. We did subgroup analyses by sex, age, region, and screening period.Findings
We identified 80 eligible studies that included 734?511 individuals. The overall prevalence of metabolic syndrome in China was 22·0% (95% CI 19·9–24·1). Its prevalence was higher in women (23·6%, 21·0–26·3) than in men (21·0%, 18·8–23·3), in urban (23·5%, 20·7–26·) than in rural regions (20·3%, 16·4–24·6), and in people older than 40 years (27·6%, 23·9–31·6) than in those aged 15–40 years (8·3%, 6·5–10·3). From 1991–1995 to 2011–2015, prevalence of metabolic syndrome rose rapidly from 8·8% (2·8–17·7) to 29.3% (21·8–37·3), with a greater rise in women (from 7·9% to 30·7%) than in men (9·4% to 27·2%).Interpretation
We found a rapidly increasing prevalence of metabolic syndrome in Chinese women. These findings suggest that more targeted lifestyle intervention and early screening programmes should be implemented for women in China.Funding
None. 相似文献19.
Background
To relieve patients' financial burden, China has established three basic health insurances: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and the New Rural Cooperative Medical Scheme (NRCMS). However, because the insured rich have more opportunity to access health care, more subsidies might be paid to them rather than the poor. We analysed the income-related benefit equity of health insurance for patients with chronic diseases to investigate who benefits most from government health insurance in China.Methods
We used data from the second phase of the China Health and Retirement Longitudinal Study (CHARLS), collected in 2013. Benefit incidence (use of inpatient care or not), benefit degree 1 (measured by subsidy paid by the basic health insurances for inpatients), and benefit degree 2 (measured by reimbursement paid by health insurances for all patients with chronic diseases, such as cancer, hypertension, and diabetes) were deployed to indicate the benefits from the health insurances. We used the decomposition of the concentration index to analyse income-related horizontal inequity of benefit incidence and benefit degree.Findings
There were 9728 patients identified for the analysis. The benefit incidence for patients with chronic diseases were 15·42% for those covered by UEBMI, 11·99% for those covered by URBMI, and 12·73% for those covered by NRCMS, while the subsidies paid by the three health insurances for inpatients (benefit degree 1) were ¥6457, ¥3127, and ¥2718, respectively, and for patients with chronic diseases (benefit degree 2) were ¥860, ¥307, and ¥279, respectively. By decomposing the concentration index, the income-related horizontal inequities of benefit incidence were 0·0868 for UEBMI, 0·1904 for URBMI, and 0·1495 for NRCMS. The horizontal inequities of benefit degree 1 and benefit degree 2 were 0·1880 and 0·4194 for UEBMI, 0·1186 and 0·3764 for URBMI, and 0·0900 and 0·2862 for NRCMS.Interpretation
With same health-care needs, high-income patients with chronic diseases benefit more than low-income patients in each of China's basic health insurances. Improvement of benefit equity should be a concern of health insurance policy development.Funding
Research Program of Shaanxi Soft Science (2015KRM117), Shaanxi Provincial Youth Star of Science and Technology in 2016, Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), National Program for Support of Top-Notch Young Professionals, China Medical Board (15-227). 相似文献20.