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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4.
Xiaojing Fan Zhongliang Zhou Shaonong Dang Yongjian Xu Jianmin Gao Zhiying Zhou Min Su Dan Wang Gang Chen 《Lancet》2017
Background
WHO recommends that women should receive at least four prenatal visits during pregnancy and at least postnatal visits after delivery. There is limited nationally representative data regarding the status of prenatal and postnatal visits since the latest health-system reform was initiated in 2009 in Shaanxi, China. The purpose of this study was to explore the current status of prenatal and postnatal visits in the background of new health-system reform.Methods
Data were drawn from two rounds of the National Health Service Survey in Shaanxi Province, which were done before and after health-system reforms in 2008 and 2013, respectively. Concentration index was used to measure the degree of income-related inequality in use of maternal health services. We obtained verbal informed consent. The study was approved by the Ethics Committee of Xi'an Jiaotong University Health Science Center (Approval No. 2015–644), and it conformed to the ethics guidelines of the Declaration of Helsinki.Findings
The study sample consisted of 2398 women aged 15–49 years. The data of the 5th National Health Services Survey in 2013 showed that, in the criterion of WHO, the percentage of women receiving at least four prenatal visits were 85% in urban areas and 82% in rural areas. The percentage of women receiving at least three postnatal visits was 26% in urban areas and 25% in rural areas. As for women in urban areas, the concentration index of postnatal visit use was ?0·075 (95% CI ?0·148 to ?0·020) after the health-system reform.Interpretation
This study showed that the use of prenatal and postnatal visits met WHO requirements. The new health-system reform increased the use of postnatal visits for poor women in urban areas. These findings show whether or not the health system reform has improved the maternal health services use. However, all the data were collected by a self-report approach, and there might be recall bias.Funding
National Program for Support of Top-notch Young Professionals and China Medical Board (15-227). 相似文献5.
Background
In 2009, China officially launched the New Health Care Reform. This study aimed to measure the occurrence of catastrophic health expenditure of households with at least one member diagnosed with chronic diseases (hereafter referred to as chronic households) in Shaanxi Province before and after the reform, and explore the influence of the New Health Care Reform on catastrophic health expenditure.Methods
The data were from the fourth and fifth National Household Health Service Surveys of Shaanxi Province. In total, 1942 chronic households in 2008 (954 in urban areas and 988 in rural areas) and 7704 households in 2013 (2870 in urban areas and 4834 in rural areas) were selected for analysis. WHO's method was used to estimate catastrophic health expenditure, which was defined as an out-of-pocket payment for health care equal to or higher than 40% of a household's capacity to pay. A multilevel logistic regression model was used to explore the influence of the New Health Care Reform on the presence of catastrophic health expenditure. We used the concentration index to measure the income-related inequality in catastrophic health expenditure.Findings
In rural areas, the proportion of households incurring catastrophic health expenditure dropped (288 [29%] households in 2008 vs 1142 (24%) in 2013; χ2 13·517, p=0·00024). However, in urban areas, the proportion of households suffering from catastrophic health expenditure increased (183 [19%] households in 2008 vs 716 [25%] in 2013; χ2 13.235, p=0·00027). After controlling for confounding variables (eg, commercial insurance, household size, having elderly members, having children, household economic status, and age, gender, education, marital status, and employment status of household head), the random-intercept logistic regression model showed a significant interaction term between year and geographic location, implying that the influence of the New Health Care Reform on catastrophic health expenditure differed between urban and rural areas. From 2008 to 2013, the concentration index of catastrophic health expenditure in rural areas increased from ?0·4572 to ?0·5499 (difference ?0·0927, Z ?2·22, p=0·026).Interpretation
Our study suggested that the implementation of the New Health Care Reform might not have been effective in reducing catastrophic health expenditure for households of patients with chronic diseases, especially in urban areas. Additionally, the income inequality of catastrophic health expenditure was greater in 2013 than in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts to develop the current health insurance system and optimise the hierarchical health-care system are required to improve protection against catastrophic health expenditure.Funding
Xi'an Jiaotong University (grant number GG1K004). 相似文献6.
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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8.
Background
The shortage of qualified health workers in rural areas is a global concern. The question of how to attract more medical graduates to work in rural areas has drawn considerable attention. However, very few studies have analysed the association between medical graduates' initial intentions and whether they ultimately opt for rural practice, and no related studies have been conducted in China.Methods
The cross-sectional survey was carried out in ten western provinces in China (Gansu, Kweichow, Inner Mongolia, Ningxia, Qinghai, Shaanxi, Sichuan, Tibet, Xinjiang, and Yunnan). No more than six medical schools in each province and no more than 100 medical students in each school were randomly selected. 4517 questionnaires were collected (response rate, 90·3%). However, only medical graduates who had found a job were included. Pearson's chi squared tests and binary logistic regression analyses were performed on data.Findings
Of 482 medical graduates included in the analysis, 61·0% (293) disclosed an initial intention of rural practice when they began to look for a job, and 68·9% (332) ultimately found a job in a rural area. Among these 332 graduates, 213 initially intended to work rurally. An increase of 1·59 times was observed in the odds of ultimately opting for rural practice in the medical graduates who initially intended to work rurally (odds ratio [OR] 1·59, 95% CI 1·08–2·36). However, after adjusting for all of the demographic variables (gender, age, residence, specialty, type of medical school, and rural clinical clerkship), it reduced to an increase of 1.0 times (1·06, 0·57–2·00) and the association became statistically insignificant. A rural background (1·90, 1·01–3·59), majoring in a specialty of non-clinical medicine (4·69, 1·80–12·24), and studying in junior colleges or below (8·87, 3·67–21·45) significantly increased the odds of ultimately opting for rural practice.Interpretation
A univariate association was identified between medical graduates' initial intentions and whether they ultimately opted for rural practice. However, the initial intentions of medical graduates did not guarantee the eventual outcomes, and it could not be concluded that all medical graduates who opted for rural practice had a genuine desire to work in rural areas. Further study is required on how to increase the likelihood that those who intend to work in rural practice fulfil these intentions, and how to ensure that there continue to be those with other intentions who eventually opt to work rurally.Funding
China Medical Board (number 10-029). 相似文献9.
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10.
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11.
Background
Fragmentation in health insurance schemes adversely affects health equity. To achieve universal health coverage by 2020, China has implemented comprehensive reforms to improve health insurance. China has three basic health insurance schemes: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and the New Rural Cooperative Medical Scheme (NRCMS). However, little research has compared the effects of different health insurance schemes on the equity of health-related quality of life. This study aimed to compare the equity of health-related quality of life of residents under any two of the schemes.Methods
Our analysis used cross-sectional survey data from the 5th National Health Services Survey of Shaanxi Province, China, with a coarsened exact matching method to control for confounding factors. We included a matched sample of 6802 respondents between UEBMI and URBMI, 34?169 respondents between UEBMI and NRCMS, and 36?928 respondents between URBMI and NRCMS. Health-related quality of life was measured by three-level EuroQol five-dimensions (EQ-5D-3L) based on the Chinese-specific value set. We adopted a concentration index to assess health equity and its contributing factors. In this study, the horizontal inequity index of health-related quality of life was obtained by removing the contributions of unavoidable variables (such as gender and age) from the overall concentration index of health-related quality of life. A positive (or negative) horizontal inequity index of health-related quality of life indicated pro-rich (or pro-poor) inequity.Findings
After matching, the mean EQ-5D utility scores were 0·9589 (SD 0·0036) and 0·9449 (0·0062) in UEBMI and URBMI, 0·9579 (0·0036) and 0·9473 (0·0016) in UEBMI and NRCMS, and 0·9505 (0·0055) and 0·9605 (0·0013) in URBMI and NRCMS, respectively. Horizontal inequity indexes were 0·0036 and 0·0045 in UEBMI and URBMI, 0·0035 and 0·0058 in UEBMI and NRCMS, and 0·0053 and 0·0052 in URBMI and NRCMS, respectively, which were mainly explained by age, educational and economic statuses. For example, between UEBMI and NRCMS, we found that age (52·15%), educational status (19·88%), and economic status (19·78%) made the largest contributions to explain the inequality of health-related quality of life for the insured residents of UEBMI.Interpretation
Our findings highlight the need to consolidate all three schemes with uniform administration, merged funding pools, and matched benefit packages. Strategies to reduce the factors that contribute to health inequity (eg, to facilitate health conditions of elderly people, narrow the economic gap, and reduce educational inequity) are essential. This study will provide evidence-based strategies on consolidating the fragmented health schemes towards reducing health inequity in both China and other developing countries.Funding
Research Program of Shaanxi Soft Science (2015KRM117), 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12.
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Youfa Wang Zhongliang Zhou Yaling Zhao Ruhai Bai Xing Wang Xiaomin Sun Weidong Qu Yaogang Wang Hong Yan 《Lancet》2017
Background
In 2015, China launched the Belt and Road Initiative (BRI; also known as the Silk Road Economic Belt and the 21st-Century Maritime Silk Road), a trade and infrastructure network to promote international collaboration. We aimed to compare health burden, health-care facilities, and resources among countries participating in the BRI, to help understand health needs, develop health promotion programmes, and facilitate collaboration on global health.Methods
In a mixed methods study, data from 1990 to 2015 were collected from the WHO, UN, and World Bank database for key health indicators and social, economic, and environmental factors (eg, gross domestic product) for China and 65 other countries participating in the BRI. We used linear and logistic regression and multilevel models in the analysis, examining impact associations of the selected health indicators and social, economic, and environmental factors.Findings
We noted large variation and shifts over time in patterns of disease burden, availability of health-care facilities (eg, numbers of doctors, nurses, hospitals, and beds), and context factors across the 66 countries. During 2000–14, life expectancy increased in almost all countries except for Iraq and Syria, by 3·9 years on average. Life expectancy was positively associated with gross domestic product per person, stronger in higher quintiles. Since 1990, mortality in children younger than 5 years has declined by 74%, from 62 deaths per 1000 livebirths in 1990 to 16 per 1000 livebirths in 2015, an annual fall of 3·0%. Economic, social, and environmental factors were closely associated with health indicators and health-care facilities and the disparities in them.Interpretation
Large variations exist in disease burden, availability of health-care facilities, and economic, social, and environmental factors across the BRI countries. This initiative provides good opportunities to study the effect of context factors and international collaboration on health outcomes.Funding
Chinese Medical Board (GNL 16-262), Xi'an Jiaotong University. 相似文献14.
Wen Zhao Biyuan Wang Andi Zhao Qi Tian Lingxiao Zhang Le Wang Xiaoai Zhao Jin Yang Danfeng Dong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(11):1535-1540
BackgroundThe role of adjuvant radiotherapy for resected ampullary carcinoma (AC) remains controversial. The aim of this study was to assess the effect of adjuvant radiotherapy on survival in patients who underwent resection for AC.MethodsThe Surveillance, Epidemiology and End Results (SEER) database was used to identify patients diagnosed with AC from 2004 to 2012. Kaplan-Meier survival curve and multivariable Cox proportional hazards analyses were conducted to determine the effect of adjuvant radiotherapy on overall survival (OS) and disease-specific survival (DSS). Propensity score matching (PSM) method was used to balance the differences of clinicopathological characteristics between groups.ResultsA total of 1227 patients were included. Patients who received adjuvant radiotherapy were younger, had more advanced T stage and N stage tumors and were more likely to receive chemotherapy (p < 0.001). Adjuvant radiotherapy failed to improve either OS (p = 0.119) or DSS (p = 0.188) in PSM cohorts. In subgroup analysis, no subgroup benefited from adjuvant radiotherapy and in patients older than 70 years, radiotherapy was associated with a worse OS and DSS.ConclusionPatients with resected AC do not benefit from adjuvant radiotherapy. 相似文献
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Jing Zhang Qiang Lu Yi-Fan Ren Jian Dong Yi-Ping Mu Yi Lv Xu-Feng Zhang 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(7):629-637
Background
Cholecystectomy is a routine procedure for treatment of upper abdominal pain (UAP) and other atypical symptoms associated with gallstones. UAP, however, persists in some cases postoperatively. The present study was to identify the risk factors relevant to persistent UAP after cholecystectomy.Methods
1714 symptomatic patients undergoing cholecystectomy for gallstones were enrolled. All the patients were asked to complete a biliary symptom questionnaire. The risk factors for persistent postcholecystectomy UAP and features related to sustained relief of postcholecystectomy UAP were evaluated.Results
172 (10%) patients complained UAP after cholecystectomy. In multivariate analysis, female gender, preoperative UAP occurring >24h before admission, and each episode of UAP >30min were independently associated with persistent postoperative UAP (all p < 0.05). 132 (76.7%) patients reported sustained relief of postcholecystectomy UAP, the causes of which remained unknown but were attributed to functional postcholecystectomy syndrome. Shorter duration of preoperative UAP (occurring within 24 h before admission), less frequency of postoperative UAP (≤1 episode per day) and administration of choleretic medications were independently associated with postoperative UAP relief (all p < 0.05).Conclusion
Females with longer historical and more frequent preoperative UAP are more likely to develop postcholecystectomy UAP. Choleretic medications are effective in relieving postoperative UAP. 相似文献16.
Meng Zhang Shuo-Lin Liu Hui-Hui Liu Geng Liu Qian Dong Jian-Jun Li 《The American journal of cardiology》2019,123(4):544-548
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