Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-02-19 Cooperative journals: 《中国全科医学》
LIAO Yanming
ZHENG Xiao
XUE Yaqing
XIAO Shujuan
XUE Benli
LI Xinru
CHEN Yiming
ZHANG Mengjie
ZHANG Chichen
Abstract： Background The severe trend of the aging population，the rapid increase in the prevalence of chronic diseases among older adults，and the greater prominence of multimorbidity have posed challenges to the prevention and treatment of chronic diseases in China. Adverse health-related behaviors are modifiable risk factors for chronic diseases. Exploring the latent classes of health-related behaviors in older adults with multimorbidity and their associations with quality of life will help identify the characteristics of their health-related behaviors and uncover risk behaviors affecting the quality of life，providing references for precise health management to improve the quality of life of older adults. Objective This study aimed to explore the latent classes of health-related behaviors in older adults with multimorbidity and the differences in the quality of life among the different classes，to provide references for conducting precise health management to improve the quality of life of older adults. Methods Based on the baseline data from the Community Health and Behavior of the Elderly Panel Study（CHBEPS）conducted by our team，a total of 1，395 older adults aged 60 years and above with multimorbidity were included as study participants. A self designed questionnaire was used to collect basic information，including disease status，smoking status，alcohol consumption，and dietary preferences of the participants. The Pittsburgh Sleep Quality Index（PSQI），International Physical Activity Questionnaire-Short-Chinese Version（IPAQ-S-C），and Lubben Social Network Scale-6（LSNS-6）were used to assess staying up late，physical activity，and social network of the participants，respectively. The EuroQol five-dimensional five-level questionnaire（EQ-5D-5L）was used to measure the quality of life of the participants. Latent class analysis of health-related behaviors among older adults with multimorbidity was conducted using Mplus 8.3 software. Based on the fitted model，the different latent classes of health-related behaviors among older adults with multimorbidity were used as groups，and the Kruskal-Wallis and Wilcoxon rank-sum tests were performed using SPSS 26.0 software to analyze the differences in quality of life among these groups. Results Four latent classes of health-related behaviors were identified among older adults with multimorbidity，which are named the health behavior group，risk behavior group，comprehensive behavior group，and adverse behavior group. There were statistically significant differences in quality of life among the four latent classes（P<0.05）. Specifically，the quality of life in the health behavior group was higher than that in the risk behavior group and adverse behavior group（P<0.05）. Conclusion When implementing precise health management for older adults with multimorbidity，the characteristics of their health-related behaviors should be taken into account. Special attention should be given to those with a higher probability of behaviors such as smoking，alcohol consumption，and a preference for sweet，spicy，and salty tastes，as well as those with a lower probability of behaviors such as a balanced diet，regular consumption of vegetables and fruits，and social networks. Additionally，measures targeted at addressing common issues such as insufficient physical activity should be implemented to improve the effectiveness of health management and the quality of life of older adults with multimorbidity.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-02-19 Cooperative journals: 《中国全科医学》
Abstract： Background Currently，research on the factors influencing the health status of older adults with multimorbidity in China is scattered，and it is difficult to give a comprehensive consideration from a holistic perspective，and the contribution of factors leading to health disparities is not explored，resulting in the ineffectiveness of current health management often programs in older adults with multimorbidity. Objective By introducing a health bifactor model，this study aims to understand the endogenous and exogenous influencing factors and their contributions to the health of older adults with multimorbidity and provide a practical basis for developing precise health management plans for older adults with multimorbidity. Methods In this study，using the China Health and Retirement Longitudinal Survey（CHARLS）2018 data and introducing the two-factor model of health developed from the Grossman health production function（including both endogenous and exogenous aspects of health determinants），first，the Wilcoxon rank sum test was used to analyze whether there were differences in the health status of older adults with multimorbidity by gender，Secondly，the OLS regression model was used to analyze the mechanism of the two-factor model of health on the health of older adults with multimorbidity，Finally，the Shapley value method was further used to decompose the contribution of health endogenous factors to their health. Results The study found that factors such as still drinking alcohol，having no disease control methods，being satisfied with medical services，having a high level of education，having a pension，not using health services，attending free health checks，caring for grandchildren and being satisfied with their children's relationship were more likely to improve the health of older people with multiple chronic conditions. The results of the Shapley decomposition showed that ＂ socioeconomic status ＂ was the most important factor in the full sample，while ＂ family health support ＂＂ health-related behaviors ＂，and ＂ health-related behaviors ＂ were the most important factors. ＂ coping strategies ＂ was the next most important，and ＂ social health resources ＂ was the least influential. In the gender subgroup analysis，socioeconomic status remained the most important factor； for older men with multiple chronic illnesses，health-related behaviors were the next most important factor； for older women with multiple chronic illnesses，coping strategies were the next most important. Conclusion The health status of elderly men with multimorbidity is better than that of women，socioeconomic status is the most important factor affecting the health of older adults with multimorbidity，and the remaining four dimensions have different contributions to the health differences between men and women. It is recommended that precise health management should be implemented according to the size of the contribution of each dimension of different health endogenous factors to improve the health status of older adults with multimorbidity with maximum benefit.
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.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-09-13 Cooperative journals: 《中国全科医学》
Abstract： Background Gout is the most common inflammatory arthritis，which causes great harm to people's health，however，there are limited studies on the trend analysis and prediction of gout burden in China. Objective To analyze the changing trend of gout in China from 1990 to 2019，and predict the standardized DALYs rate，incidence rate and prevalence rate of gout in the next 10 years. Methods The indicators of disability-adjusted life years（DALYs），incidence，and prevalence of gout in China were extracted from the Global Burden of Disease Study（GBD2019），the annual percentage change （APC） and annual average percentage change（AAPC） of the age-standardized DALYs rate，age-standardized incidence rate and age-standardized prevalence rate were calculated using the Joinpoint regression model，autoregressive integrated moving average model（ARIMA model） was used to predict the the age-standardized DALYs rate，age-standardized incidence rate and age-standardized prevalence rate in 2020-2029. Results In 1990-2019，the DALYs of gout in China increased from 187 436 to 510 485 person-years，with an increase of 172.35%，the number of cases increased from 1 181 969 to 3 0411 329，with an increase of 157.31%，the number of patients increased from 5 864 143 to 16 161 325，with an increase of 175.60%（the corresponding standardized rates increased by 28.45%，25.92% and 28.63%，respectively）. Joinpoint regression results showed an overall increasing trend in the age-standardized DALYs rate，age-standardized incidence rate and age-standardized prevalence rate（AAPC was 0.9%，0.8%，0.9%，respectively，P<0.05） from 1990 to 2019. The gout burden had significant gender and age differences，with men having a higher burden than women，and the range of the male-to-female gender ratios for the standardized DALYs rate，standardized incidence rate，and standardized prevalence rate was 3.23 to 3.51，3.14 to 3.40，and 3.17 to 3.42，respectively. The age peaks for each indicator were generally delayed in females compared to males，the burden began to increase in females after 45 years of age，and the burden increased again after 90 years of age for both males and females. The ARIMA model results showed that the age-standardized DALYs rate and age-standardized incidence rate due to gout are projected to decrease by 0.33% and 0.45%，respectively，and the age-standardized prevalence rate to increase by 0.71% by 2029. Conclusion From 1990 to 2019，the gout burden in China showed an obvious increasing trend，with significant gender and age differences，and a trend of younger age. The age-standardized prevalence rate due to gout is expected to increase slightly by 2029.
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%
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-04-19 Cooperative journals: 《中国全科医学》
Abstract： Background The cost of end-of-life care is an important topic in health and wellness sector. There are few studies focus on the end-of-life medical expenditures of older adults in China，especially the causes of urban-rural differences in end-of-life medical expenditures in this population. Objective To investigate the associated factors of medical expenditures of Chinese oldest old population（≥ 80 years）in the year before their death，and to analyze rural-urban differences in the medical expenditures as well as their causes. Methods In September 2021，1 399 oldest-old adults who died in 2014—2018 with full data of medical expenditure and other key variables in the year prior to their death were selected from the participants of Chinese Longitudinal Healthy Longevity Survey 2018. Ordinary least squares regression was used to analyze the associated factors of the medical expenditures. The Oaxaca-Blinder technique was used to decompose urban-rural differences in the expenditures. Results The median medical expenses of the participants in the year prior to their death was 3 500.00 yuan，and the interquartile range was 9 000.00 yuan，the logarithmic mean value was（8.09±1.73）yuan. The residence，age at death，gender，marital status，living arrangement，prevalence of disability，prevalence of endowment insurance，place of death，accessibility of medical services，prevalence of being confined to bed，and annual household income per capita were factors associated with the medical expenditures in the year prior to death（P<0.05）. After controlling for confounding factors，the medical expenses of the urban participants in the year prior to their death was 42.6% higher than that of participants living in rural areas. According to the findings of Oaxaca-Blinder decomposition，the explainable and unexplainable parts of the urban-rural differences accounted for 32.86% and 67.14%，respectively. Of the explainable part，18.70% was caused by differences in endowment insurance participation，30.18% by differences in place of death，and 40.42% by differences in annual household income per capita. Conclusion The medical expenditures in the year prior to death in the oldest-old were associated with complex factors，and showed large urban-rural differences. It is essential that efforts should be made to implement healthy aging strategies，balance the allocation of urban and rural medical resources，improve social security system for older adults，and to develop end-of-life care. All of these will help reduce the medical expenditures and improve the quality of life and death of older adults at the end of their life.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-03-28 Cooperative journals: 《中国全科医学》
Abstract： Background Multimorbidity have become a major character in the course of chronic diseases that brings a challenge for public health in China. The development of multimorbidity research in China is in an early stage with fewer literature，and there is a lack of systematic and comprehensive literature analysis. Objective To conduct a bibliometric and visual analysis of research hotspots and evolutionary trends in the field of multimorbidity in China，grasp the research frontiers and development directions in the field，thereby providing a reference for future research directions. Methods CNKI（Chinese data source）and WOS（foreign data source） were searched for the literature in the field of multimorbidity researches published by Chinese researchers. CiteSpace software was used to analyze the spatial and temporal distribution of multimorbidity and explore the research hotspots and evolutionary trends in the field of multimorbidity by plotting the collaboration network map of institutions and co-occurrence map of keywords for researches in the field of multimorbidity published by Chinese researchers. Results The number of published literatures in the field of multimorbidity showed an increasing trend from 2002 to 2022. The top 5 Chinese keywords were “comorbidity （342）”“older adults（161）”“depression （155）”“chronic diseases （106）”“diabetes （94）”；and the top 5 English keywords were “prevalence （126）”“older adults （92）”“multimorbidity （91）”“health （75）” “disease（71）”. There were 4 development stages in the research development history of multimorbidity: The initial stage of research，the researchers focused on the comorbidity characteristics but did not define it in a uniform way；The second stage of research，the researchers focused on comorbidity and chronic disease in older adults，discovered the high prevalence of multimorbidity in the elderly population；The third stage of research，the domestic researches on multimorbidity developed rapidly，involving influencing factors，comorbidity patterns，polypharmacy，quality of life and debilitation；The fourth stage of research，the definition of multimorbidity is becoming clearer，showing a trend of research diversification. Conclusions Researches in the field of multimorbidity is becoming increasingly diversified. Researchers should focus on the prevention and treatment of complex multimorbidity，and construct health management strategies and community intervention programs for multimorbidity population in China.
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