• Research on the Efficiency and Equity of Rural Medical and Health Resources Allocation in China Based on DEA-GIS Methodology

    Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-11-20 Cooperative journals: 《中国全科医学》

    Abstract: Background  "Strengthening primary health care" is one of the focuses of China's health care reform,and the study of the efficiency and equity of rural medical and health resources allocation in China is of great significance in promoting the orderly development of primary health care services,but at present,there are few relevant literature based on the DEA-GIS methodology with both equity and efficiency. Objective  To analyze the efficiency and equity of rural medical and health resources allocation in 29 provinces in China in 2020,in order to provide a reference for optimizing the allocation of rural medical and health resources and improving the rural medical and health service system in China. Methods  The data for this study were collected from the Statistical Tables of Administrative Divisions of the People's Republic of China,the 2021 China Health Statistical Yearbook. After synthesizing the existing literature research,data availability and soliciting expert advice,the township hospitals and village clinics in 29 provinces in China(excluding Beijing,Shanghai,Hong Kong,Macao and Taiwan) were selected as the study objects,and the number of township hospitals and village clinics(hereinafter referred to as the number of health institutions),the number of beds in township hospitals(hereinafter referred to as the number of beds),and the number of health technicians in township hospitals and village clinics(hereinafter referred to as the number of health technicians) were used as input indicators; the number of consultations in township hospitals and village clinics(hereinafter referred to as the number of consultations),and the number of hospital admissions to township hospitals(hereinafter referred to as the number of admissions)were used as output indicators. The data envelopment analysis(DEA) model was used to assess the efficiency of rural medical and health resources allocation in China,and the agglomeration and geographic information system (GIS) technology were used to spatially map the rural medical and health resources allocation to analyze its equity. Results  In 2020,China's rural medical and health resources had 4 provinces with effective DEA,7 provinces with weakly effective DEA,and 18 provinces with ineffective DEA. Among them,the DEA ineffective regions all had different degrees of excess inputs,and only Shandong Province and Tibet Autonomous Region had insufficient outputs. The results of regional analysis showed that rural medical and health resources were concentrated in the eastern region,followed by the central region,with the lowest degree of concentration in the western region. Conclusion  The government needs to pay attention to improving the technical efficiency of rural medical and health resources allocation,and promote equity and efficiency by applying precise measures to each region based on optimizing the input and output structure,reducing resource redundancy,rationally coordinating the allocation of resources in the eastern,central and western regions.

  • Correlation between Serum Uric Acid to High-density Lipoprotein Cholesterol Ratio and Metabolic Syndrome in Middle-aged and Elderly Population in China

    Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-08-17 Cooperative journals: 《中国全科医学》

    Abstract: Background  The prevalence of metabolic syndrome(MS)among the middle-aged and elderly population in China increases with age,serum uric acid to high density lipoprotein cholesterol ratio(UHR)is closely associated with various metabolic diseases,however,there are few studies on the relationship between UHR and MS in middle-aged and elderly people. Objective  To explore the correlation between UHR and MS in middle-aged and elderly people in China,and evaluate the predictive value of UHR for MS. Methods  This study used public data from the 2015 China Health and Retirement Longitudinal Survey(CHARLS)and included 9 233 subjects. General data,physical examination indexes and blood biochemical examination indexes were collected from the study subjects and their UHR was calculated. The subjects were divided into the non-MS group(n=7 006)and MS group(n=2 227)according to whether they had MS. At the same time,the subjects were divided into the Q1 group(UHR ≤ 7.32%,n=2 308),Q2 group(7.32%12.20%,n=2 308)according to the level of the quartiles of UHR. Pearson correlation analysis was used to explore the correlation between UHR and metabolic indexes. The relationship between UHR and MS was studied by multivariate Logistic regression analysis. The receiver operating characteristic(ROC)curves for the risk of MS predicted by UHR in the overall and by different genders were plotted separately and the areas under the ROC curve(AUC)were calculated. Results  The proportion of females,age,urban household proportion,history of hypertension,diabetes and dyslipidemia,proportion of taking lipid-lowering drugs,glycated hemoglobin,C-reactive protein,triglyceride(TG),total cholesterol(TC),fasting plasma glucose(FPG),SUA,systolic blood pressure(SBP),diastolic blood pressure(DBP),BMI,waist circumference(WC)and UHR in the MS group were higher than the non-MS group,while HDL-C,low-density lipoprotein cholesterol(LDL-C)and estimated glomerular filtration rate(eGFR)were lower than those in the non-MS group,and there were statistically significant differences in education level,smoking and alcohol consumption between the two groups (P<0.05). With the increase of UHR level,the detection rates of MS,central obesity,hyperglycemia,hypertension,hypertriglyceridemia and low HDL-C in Q1-Q4 groups showed an increasing trend(Ptrend<0.01). There were significant differences in BMI,WC,SBP,DBP,TG,HDL-C,LDL-C,TC,FPG,eGFR and C-reactive protein among Q1-Q4 groups(P<0.01). The results of Pearson correlation analysis showed that UHR was positively correlated with TG,FPG,DBP,SBP,BMI and WC(P<0.01),and negatively correlated with HDL-C(P<0.01). After gender stratification,UHR in males and females were positively correlated with TG,FPG,DBP,SBP,BMI and WC(P<0.01),and negatively correlated with HDL-C(P<0.01). Multivariate Logistic regression analysis showed that compared with the Q1 group,there was an increased risk of MS prevalence in the male Q4 group〔OR=3.385,95%CI=(1.778-6.444),P<0.01〕and female Q4 group〔OR=2.886,95%CI=(1.991-4.184),P<0.01〕. ROC curve analysis showed that the AUC for UHR predicting MS for the study population was 0.735〔95%CI(0.723-0.746)〕,the AUC for UHR predicting MS for male group was 0.773〔95%CI(0.757-0.790)〕. the AUC for UHR predicting MS for female group was 0.750〔95%CI(0.735-0.766)〕. Conclusion  There was a positive correlation between the increased UHR level and risk of MS among the middle-aged and elderly population in China,UHR closely correlates to MS and its components,UHR might serve as a risk factor and demonstrated good predictive value for MS in middle-aged and elderly people.