Annual Disposable Income Research Articles

Analysis of affordability differences for rare diseases in China: a comparison across disease types and regions

BackgroundChina has implemented policies to make rare diseases more affordable. While previous studies evaluated overall affordability, few have examined affordability differences across regions and disease types. Given the vastness of China and varying medical policies across cities, this study assesses the affordability of rare diseases based on China’s First List of Rare Diseases (CFLRD), National Reimbursement Drug List (NRDL), and outpatient chronic and special disease policies in each prefecture.MethodSix rare diseases were selected and the average annual treatment cost of all relevant drugs in NRDL was calculated for each disease. Based on the WHO/HAI standardized approach, the study analyzed 289 cities with outpatient chronic and special disease policies, measured the security levels by the actual reimbursement ratio of Basic Medical Insurance (BMI) and affordability by the ratio of individual expenses after reimbursement to the annual disposable income of urban residents in the province. The security levels and affordability differences across disease types and provinces were analyzed using the Mann-Whitney U test and the K-W test.ResultThe affordability of rare diseases varied significantly on the disease types and annual treatment cost. Diseases with an annual treatment cost below 100 000 yuan are affordable to all prefectures even with low reimbursement rates, while those with a higher treatment cost were not affordable in at least 80% of prefectures even though the reimbursement ratio is high. The affordability of the same disease varies significantly across provinces and municipalities. Outpatient chronic and special diseases insurance and critical illness insurance, and the inconsistencies between them, result in regional differences.ConclusionAlthough China has made progress in improving the affordability of rare diseases, significant differences persist between cities and diseases. The study suggests the optimization of the BMI system and explores independent funds and innovative insurance models to enhance the affordability of rare diseases, particularly those with extremely high treatment costs.

Differences in amounts of saving generated by selected European countries

The aim of the paper is to estimate – for twenty-four selected European countries – the influence of the deviations of two factors on the deviation of annual gross national saving per inhabitant. In order to do so, causal analysis has been conducted. The amount of annual gross national disposable income per inhabitant and the average propensity to save have been adopted as the variables affecting the value of saving per capita. Three research hypotheses have been verified in this paper. Data concerning 2021 and 2022 have been used for calculations.

Chinese Adults’ Willingness to Pay for Mandatory Nutrients Reporting on Nutrition Facts Table

The Chinese food industry has opposed the mandatory inclusion of increased nutrients in the Nutrition Facts Table (NFT), thus impeding its improvement. This poses a challenge to the endeavors aiming to assist consumers in cultivating healthy dietary habits that incorporate reduced saturated fatty acids and added sugars while ensuring the adequate intake of essential micronutrients. This study conducted a choice experiment to investigate Chinese consumers’ preference for updated labeling schemes among 630 adults that were randomly selected from Central, North, East, South, Northwest, Southwest, and Northeast China. It revealed that respondents were willing to pay the highest premium for the most mandatory nutrients (22.575% of the food price per unit). Respondents preferred the NFT with the most mandatory nutrients if they met the following population characteristics: female; non-overweight or obese; without a college degree; possessed an annual household disposable income between 50,000 and 99,999 CNY; from North China; lived in rural areas and often cooked for family; cared about food nutrition. Two combinations of NFT information received the highest preference: (1) the NFT detailing the most mandatory nutrients and their content values and nutrient reference values (NRV%); (2) the NFT containing the most nutrients and the nutrients in 100 g/mL or a serving. The first and second combinations attracted a premium of 14.884% and 31.833% of the food price per unit, respectively.

Constructing efficient strata boundaries in stratified sampling using survey cost

For maximum precision in population parameter estimation under the Stratified sampling design, the optimum strata boundaries (OSB) could be constructed based on a continuous study variable rather than a set of categorical variables. If constructed optimally, the OSB results in homogenous units within each stratum leading to optimal stratum sample sizes (OSS) as well. The OSB and OSS may not remain optimum if the problem is considered in terms of a fixed total sample size, especially when a survey design involves a fixed budget. This article suggests a methodology for computing the OSB and OSS when the per unit stratum measurement costs for the survey or its probability density function are known. To plan for such a stratified survey, we demonstrate a design-based stratification empirically by using Wave 18 of the HILDA Survey general release dataset where we estimate the mean level of Gamma-distributed annual total disposable income in Australia, which could potentially be an important variable for policy decision-making. We also provide numerical illustrations for hypothetical study variables that follow exponential and right-triangular distributions respectively. The findings indicate that the suggested method is satisfactory in the sense that it is either more efficient or relatively comparable with other methods aimed at improving the accuracy of population parameter estimates. The proposed technique has been implemented in the updated stratifyR package.

The determinants of household electricity demand in Turkey: An implementation of the Heckman Sample Selection model

Residential areas have a significant share in electrical energy consumption in Turkey. At this point, determining electricity consumption demand in residential areas will significantly contribute to ensuring energy efficiency throughout the country. Accurate econometric modelling of the relationships between the various socio-economic characteristics of households and their energy consumption/expenditure can serve as a basis for policymakers when planning investments aimed at efficiency on primary energy consumption in residences. Considering these issues, this study aims to examine the electricity consumption demand in residential areas in Turkey in terms of various socio-economic and building and property characteristics variables. At this point, the fact that some households have zero electricity consumption has led to the need to use censored regression models. The Heckman Sample Selection model was used, which makes it possible to estimate the consumption decision of individuals in two stages and eliminates the parameter bias problem caused by linear regression analysis. Heckman Sample Selection modelling was carried out in the study using Turkish Statistical Institute (TURKSTAT) 2019 Household Budget Survey data. According to the results, it has been determined that annual disposable income, various demographic variables (age, education level, marital status), characteristics of the house (size) and the presence of various electrical household appliances (air conditioner, tumble dryer, deep freezer) have significant effects on electricity consumption. The systematic preparation of informative brochures on the effective use of household electrical appliances can significantly contribute to efficiency. In addition, in countries like Turkey that depend on foreign energy, providing incentives towards renewable energy sources is considered necessary to contribute to the country's economy positively.

Income disparities between adult childhood cancer survivors and their peers-A register-based cohort study from the SALiCCS research programme.

Childhood cancer survivors face various adverse consequences. This Nordic register-based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age-, sex-, and country-matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990-2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16-1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to transition from low to middle/high income and 12% (10%-15%) more likely to transition from middle/high to low income during follow-up. Among those initially in the low income category, survivors were 7% (95% CI 3%-11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to remain in the middle/high income and 45% (37%-53%) more likely to transition to the low income category permanently. Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.

Class, Family, Income and Wealth: Farming and Non-Farming Landowners in the Occupational and Social Class Orders in Turkey

This study presents the trajectory of changes in land ownership and land use and of the differences observed since the mid-1990s in the average amount of annual disposable income (and of wealth) within and between farming and non-farming landowning households in Turkey. The study makes use of the data sets of the Household Budget Surveys conducted by the Turkish Institute of Statistics (TUIK) in 1994, 2002, 2005, 2010, 2015 and 2017. The data sets have been analysed in connection with four main themes: (i) the patterns of structural change in landownership and land use, (ii) the patterns of structural change in the locations of farming and non-farming landowners in the occupational and social class orders, (iii) the patterns of changes and the persistence of differences in the average amounts of annual disposable incomes and wealth within and between the social classes of farming and non-farming landowners and (iv) the effect of family type on the differences of income and wealth. The results indicate that Turkish agrarian structures have undergone significant structural changes in the last quarter of a century, and there are persisting and significant differences of income (and of wealth) at the national level as well as among farming and non-farming landowning households. However, the same kind of differences do not hold true for differences in the average amount of farm land owned. On the contrary, these differences have strong associations with family type among farming as well as non-farming households.

Health-related quality of life and economic burden in Chinese patients with cutaneous T-cell lymphoma.

e19533 Background: Cutaneous T-cell lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma. As described in European Organization for Research and Treatment of Cancer Consensus, the subtypes of mycosis fungoides (MF) and Sézary Syndrome (SS) comprised roughly 55% and 5% of CTCL, respectively. The clinical presentations of MF and SS include skin lesion, tumors, ulcerations, systemic involvements and even death. This study aimed to measure the overall HRQoL and economic burden of MF and SS patients in China. Methods: A cross-sectional survey was conducted from 21 July 2022 to 24 October 2022. Eligible adult participants with a pathologically confirmed diagnosis of either MF or SS were recruited from specialty or general hospitals across China. All participants were asked to complete a questionnaire that assessed HRQoL and annual economic burden. Validated instruments in Chinese, specifically the EuroQoL Group’s five-level QoL five-dimensional questionnaire (EQ-5D-5L), Functional Assessment of Cancer Therapy-General (FACT-G), and Skindex-29, were used to assess general, cancer and skin-related HRQoL. All HRQoL outcomes were calculated using the scoring system provided by the institutions, and EQ-5D utility scores were mapped using the China time trade-off value sets. As for economic burden, it was investigated from the societal perspective, as the direct medical costs, direct non-medical costs, and productivity loss were all calculated. Results: A total of 61 patients were recruited and completed the survey. Patients resided in 38 cities of 21 provinces across China. 56 patients (92%) were diagnosed with MF and 5 (8%) with SS. 56% were male, with a mean age of 39 years. Half of the patients had early-stage disease (defined as less than stage IIB, patch or plaque), with the remainder having late-stage disease. Among the recruited patients, 43 (70%) received skin-directed therapy, and 55 (90%) received systemic therapy. As for HRQoL measures, EQ-5D utility score was 0.79 (±0.18), FACT-G score was 61.3 (±12.4), and the Skindex-29 score was 43.4 (±24.2). Comparison between patients with early-stage disease and late-stage is presented in the table. As for economic burden, the annual per capita cost for MF and SS patients was CNY 86,729 (USD 12,428), which greatly exceeded the annual disposable income in 2022 (CNY 36,883, equals USD 5,440). Conclusions: This was the first study investigating economic burden and HRQoL using patient-reported outcomes conducted in mainland China. The findings suggested that MF and SS has significantly compromised patients’ HRQoL and posed substantial economic burden. [Table: see text]

Vulnerability to HIV Infection Among International Immigrants in China: Cross-sectional Web-Based Survey.

The rising number of migrants worldwide, including in China given its recent rapid economic development, poses a challenge for the public health system to prevent infectious diseases, including sexually transmitted infections (STIs) caused by risky sexual behaviors. The aim of this study was to explore the risky sexual behaviors of international immigrants living in China to provide evidence for establishment of a localized public health service system. Risky sexual behaviors were divided into multiple sexual partners and unprotected sexual behaviors. Basic characteristics, sexual knowledge, and behaviors of international immigrants were summarized with descriptive statistics. Multivariate logistic regression analyses were used to identify factors associated with risky sexual behaviors, and the associations of demographic characteristics and risk behaviors with HIV testing and intention to test for HIV. In total, 1433 international immigrants were included in the study, 61.76% (n=885) of whom had never heard of STIs, and the mean HIV knowledge score was 5.42 (SD 2.138). Overall, 8.23% (118/1433) of the participants had been diagnosed with an STI. Among the 1433 international immigrants, 292 indicated that they never use a condom for homosexual sex, followed by sex with a stable partner (n=252), commercial sex (n=236), group sex (n=175), and casual sex (n=137). In addition, 119 of the international immigrants had more than three sex partners. Individuals aged 31-40 years were more likely to have multiple sexual partners (adjusted odds ratio [AOR] 2.364, 95% CI 1.149-4.862). Married participants were more likely to have unprotected sexual behaviors (AOR 3.096, 95% CI -1.705 to 5.620), whereas Asians were less likely to have multiple sexual partners (AOR 0.446, 95% CI 0.328-0.607) and unprotected sexual behaviors (AOR 0.328, 95% CI 0.219-0.492). Women were more likely to have taken an HIV test than men (AOR 1.413, 95% CI 1.085-1.841). Those who were married (AOR 0.577, 95% CI 0.372-0.894), with an annual disposable income >150,000 yuan (~US $22,000; AOR 0.661, 95% CI 0.439-0.995), considered it impossible to become infected with HIV (AOR 0.564, 95% CI 0.327-0.972), and of Asian ethnicity (AOR 0.330, 95% CI 0.261-0.417) were less likely to have an HIV test. People who had multiple sexual partners were more likely to have taken an HIV test (AOR 2.041, 95% CI 1.442-2.890) and had greater intention to test for HIV (AOR 1.651, 95% CI 1.208-2.258). International immigrants in China exhibit risky sexual behaviors, especially those aged over 30 years. In addition, the level of HIV-related knowledge is generally low. Therefore, health interventions such as targeted, tailored programming including education and testing are urgently needed to prevent new HIV infections and transmission among international immigrants and the local population.

Cost-Effectiveness of Presbyopia Correction Among Seven Strategies of Bilateral Cataract Surgery Based on a Prospective Single-Blind Two-Center Trial in China.

The aim of this study was to explore a method to rank the cost-effectiveness of presbyopia correction in diverse strategies of bilateral cataract surgery to provide references for healthcare policymakers in rationalizing resource utilization and surgeons in customizing patient management. The cost-effectiveness analysis based on a prospective single-blind two-center clinical trial included seven strategies in bilateral cataract surgery: monofocal, monovision, diffractive bifocal, blended, refractive bifocal, trifocal, and extended depth of focus (EDOF) strategies. The effectiveness according to the objective spectacle independence rate (hereafter "rate", a novel indicator defined as the proportion of patients with binocular uncorrected distance, intermediate and near visual acuity all better than 0.1logMAR, logarithm of the minimum angle of resolution), costs, average cost-effectiveness ratios (ACERs, $/1% rate), and incremental cost-effectiveness ratios (ICERs, $/1% incremental rate) were estimated. In 194 participants (388 eyes), the trifocal strategy achieved the highest rate [93.10% (95% confidence interval (CI) 83.8-102.35%)]. The refractive bifocal strategy had the minimum ACER [$45.54/1% rate (95%CI 34.57-56.50)], followed by the blended [$59.10/1% rate (95%CI 31.72-86.48)], diffractive bifocal [$69.06/1% rate (95%CI 30.89-107.21)], EDOF [$72.85/1% rate (95%CI 52.02-93.70)], trifocal [$93.01/1% rate (95%CI 83.23-102.79)], monovision [$136.83/1% rate (95%CI - 55.40 to 329.14)], and monofocal [$264.45/1% rate (95%CI - 97.45 to 626.55)] strategies. Compared with the refractive bifocal strategy, the probabilities that the trifocal strategy (ICER $289.74/1% incremental rate) is very cost-effective and cost-effective were 81.7% and 93.2%, respectively, at the wiliness-to-pay threshold of one and three times China's annual disposable income per capita in 2021 per 10% incremental rates. Cost-effectiveness analysis with ACER and ICER according to objective spectacle independence rate is a helpful tool to identify highly cost-effective presbyopia-correcting strategies in cataract surgery for clinical and policy decisions. Clinicaltrials.gov (NCT04265846).

Spending and Hospital Stay for Melanoma in Hunan, China

ObjectiveThis study aimed to describe the economic burden of Chinese patients with melanoma in Hunan province of China, and to investigate the factors for hospitalization spending and length of stay (LOS) in patients undergoing melanoma surgery.MethodsData was extracted from the Chinese National Health Statistics Network Reporting System database in Hunan province during 2017–2019. Population and individual statistics were presented, and nonparametric tests and quantile regression were used to analyze the factors for spending and LOS.ResultA total of 2,644 hospitalized patients with melanoma in Hunan were identified. During 2017–2019, the total hospitalization spending was $5,247,972, and out-of-pocket payment (OOP) was $1,817,869, accounting for 34.6% of the total expenditure. The median spending was $1,123 [interquartile range (IQR): $555–2,411] per capita, and the median LOS was 10 days (IQR: 5–18). A total of 1,104 patients who underwent surgery were further analyzed. The non-parametric tests and quantile regression showed that women were associated with less spending and LOS than men. In general, patients aged 46–65 and those with lesions on the limbs had higher hospitalization costs and LOS than other subgroups.ConclusionMelanoma causes heavy economic burdens on patients in Hunan, such that the median spending is close to 60% of the averagely annual disposable income. Middle-aged men patients with melanoma on the limbs present the highest financial burden of melanoma.

County-city consolidation and sustainability: Empirical evidence from Taiwan’s local experience in the 2010s

ABSTRACT Governmental sustainable development pertains to the realm of collective action, which generates economies of scale in which the actors share the costs of their actions. Through consolidation, an originally adjoint city is merged with a county, facilitating the sustainable development of collective action within local governments. This study empirically corroborated the relationship between the time since local government consolidation (in years) and sustainability. Open government data were used to establish a secondary database; data from Taiwan’s 22 cities and counties were collected over a multiyear period, before and after county-city consolidation. Time-series analysis and event history analysis (survival analysis models) were employed to corroborate whether county-city consolidation positively affects sustainability. County-city consolidation contributed to improvements in sustainability, only in regard to the growth rate of per capita annual disposable income and the growth rate of tertiary education of 15+ age in the jurisdictions. This research then concluded that the extreme integration approach of local governments under county-city consolidation may promote collective sustainability-related benefits, but it may simultaneously enlarge the poverty gap in the society.

Clinical comprehensive evaluation of Reyanning Mixture in treatment of acute upper respiratory tract infection (heat-toxin attacking lung syndrome)

This study systematically sorted out the evidence data of the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine(TCM) of Reyanning Mixture in the treatment of acute upper respiratory tract infection(heat-toxin attacking lung syndrome) with the qualitative and quantitative evaluation methods adopted. Based on evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, pharmacoeconomics, and health technology evalua-tion(HTA), the clinical value of Reyanning Mixture was evaluated using multi-criteria decision analysis(MCDA) model, Chinese patent medicine clinical evidence, and value evaluation software(CSC v2.0). The SRS monitoring data, Meta-analysis, and other safety evidence showed that the main adverse reactions of Reyanning Mixture were nausea, diarrhea, and rash, and no serious adverse reactions were found. The pharmacovigilance system was sound, and the system was perfect. There was no recall, notification, or interview for unqualified products. Based on the existing research, the evidence was sufficient, and the risk was controllable. Hence, its safety was grade A. Meta-analysis showed that in the treatment of acute upper respiratory tract infection, Reyanning Mixture combined with Amoxicillin Capsules was better than Amoxicillin Capsules alone in shortening the complete fever relief time and improving the cure rate. Besides, it was superior to Shuanghuanglian Granules in shortening the complete fever relief time, cough relief time, nasal congestion relief time, and pharyngeal congestion relief time. The Meta-analysis was conducted based on AMSTAR standard, and its ove-rall quality was proved good. The evidence quality in GRADE system evaluation was medium and low. The quality of evidence was medium, and the clinical value was obvious. Hence, its effectiveness was grade A. The results of pharmacoeconomic research showed that compared with Amoxicillin Capsules, Reyanning Mixture alone or in combination with Amoxicillin Capsules had cost-effectiveness advantages in the treatment of acute upper respiratory tract infection, and the results were stable in sensitivity analysis. According to the CASP economic evaluation checklist, the research problems were clear and the results were reliable. As revealed by the comprehensive evaluation, the evidence quality was sufficient and the result was clear. Its economy was grade B. Reyanning Mixture had multiple therapeutic targets like anti-virus, anti-bacteria, antipyresis, and anti-cough, with good clinical innovation. There were many innovative initiatives in ensuring drug supply, especially at the grass roots, drug safety, and effectiveness, and also multiple innovative contributions to production technology, quality control, scientific and technological research and development, and enterprise management and marketing. Therefore, its innovation was grade B. The dosage form of Reyanning was mixture, which made it convenient for storage and transportation. The usage was easy to be mastered and accepted by doctors and nurses, exhibiting good suitability for clinicians, nurses, pharmacists, and patients who received this drug and basically meeting the needs of clinical medication. The suitability was grade B. The average daily cost of this drug was 8.082 yuan, and the price was low. The treatment cost accounted for a small proportion of the annual disposable income of urban and rural residents, indicating that it was affordable. Reyanning Mixture was available in 31 provinces, cities and autonomous regions, covering 6 910 hospitals. The allocation of hospitals at all levels was more than 50%. There was no shortage or supply restriction of medicinal material resources. The annual production capacity was sufficient to meet the supply demand, so its accessibility was grade A. Reyanning Mixture, sourced from "pneumonia Ⅲ", has been subjected to a real-world study of its clinical application, with 4 367 cases involved, and the characteristic of TCM was grade B. The comprehensive evaluation results demonstrated that the clinical value score of Reyanning Mixture in the treatment of acute upper respiratory tract infection(heat-toxin attacking lung syndrome) was 0.80, making it rated class A. According to the Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021), it is recommended to convert it into the relevant policy results of basic clinical medication management according to the procedures.

Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: a cohort study

ObjectiveDetermine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19.DesignNationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals...

Economic burden of measles and its influencing factors in Fujian, China

ABSTRACT Background Measles is a highly-contagious, serious diseases that can lead to potentially fatal illness, disability and death . We conducted an investigation to calculate the economic burden of measles cases from 2018 to 2019 and to analyze factors that influenced the total costs of measles cases in Fujian Province, China. Methods We investigated confirmed cases of measles by telephone interview, from 2018 to 2019, including demographic characteristics, therapeutic measures, self-treatment and nutritional supplement expenditure, transportation fees, and lost wages. Medical expenses in the hospitals were obtained from the hospital service charge system. Results A total of 131 measles cases were investigated, the average direct cost, indirect cost, and total cost were $518, $284, and $802, respectively. The total cost was 15.5% of Annual Per Capita Disposable Income of Households ($5 162) in Fujian. Hospitalization (OR = 98.6, 95%CI: 21.1 ~ 460.6) and complication (OR = 8.7, 95%CI: 1.3 ~ 58.0) significantly influenced the total cost according to binary logistic regression, and an outbreak of measles may pose a significant threat to household finances in a short term. Conclusions The economic burden of measles was high when compared with Annual Per Capita Disposable Income of Households. The resurgence of measles and measles outbreaks increased economic burden of household finances.

Socio-demographic and psychosocial characteristics of male and female perpetrators in intimate partner homicide: A case-control study from Region Västra Götaland, Sweden.

Risk factor studies on male-perpetrated intimate partner homicide (IPH) are often compared with studies on intimate partner violence (IPV) or non-partner homicide perpetrators. This not only excludes female perpetrators, but also fails to take socio-demographic and psychosocial differences between perpetrators and the general population into consideration. The aim of this study was to examine male- and female-perpetrated IPH cases, and to compare socio-demographic factors in IPH perpetrators and in matched controls from the general population. Data were retrieved from preliminary inquiries, court records and national registers for 48 men and 10 women, who were perpetrators of IPH committed in 2000–2016 and residing in Region Västra Götaland, Sweden. The control group consisted of 480 men and 100 women matched for age, sex and residence parish. Logistic regression, yielding odds ratios (OR) with 95% confidence intervals (CI), was performed for male perpetrators and male controls to investigate associations for selected socio-demographic and psychosocial characteristics. This was not performed for females due to the small sample size. Female perpetrators were convicted of murder to a lesser extent than male perpetrators. No woman was sentenced to life imprisonment while five men were. Jealousy and separation were the most common motivational factors for male perpetration while the predominant factor for female perpetrators was subjection to IPV. Statistically significant differences were found between male perpetrators and male controls in unemployment rate (n = 47.9%/20.6%; OR 4.4; 95% CI 2.2–8.6), receiving benefits (n = 20.8%/4.8%; OR 5.2; 95% CI 2.3–11.7) and annual disposable income (n = 43.8%/23.3% low income; OR 5.2; 95% CI 1.9–14.2) one year prior to the crime. Female IPH perpetrators were less educated than female controls (≤ 9-year education 30%/12%) and were more often unemployed (70%/23%) one year before the crime. Male and female IPH perpetrators were socio-economically disadvantaged, compared with controls from the general population.

Impact of the National Health Insurance Coverage Policy on the Utilisation and Accessibility of Innovative Anti-cancer Medicines in China: An Interrupted Time-Series Study.

Objective: The study aimed to evaluate the impact of the National Health Insurance Coverage (NHIC) policy on the utilisation and accessibility of innovative anti-cancer medicines in Nanjing, China.Methods: We used the adjusted World Health Organisation and Health Action International methodology to calculate the price and availability of 15 innovative anti-cancer medicines included in the National Health Insurance drug list in 20 tertiary hospitals and six secondary hospitals in Nanjing before and after NHIC policy implementation. Interrupted time-series regression was used to analyse the changes in the utilisation of the study medicines.Results: The price reduction rates of innovative anti-cancer medicines ranged between 34 and 65%. The mean availability rate was 27.44% before policy implementation and increased to 47.33% after policy implementation. The utilisation of anti-cancer medicines suddenly increased with a slope of 33.19–2,628.39 when the policy was implemented. Moreover, the usage rate of bevacizumab, bortezomib, and apatinib significantly increased (p < 0.001, p = 0.009, and p < 0.001, respectively) after policy implementation. With regard to price reduction and medical insurance reimbursement, the medicines became more affordable after policy implementation (0.06–1.90 times the per capita annual disposable income for urban patients and 0.13–4.46 times the per capita annual disposable income for rural patients).Conclusion: The NHIC policy, which was released by the central government, effectively improved the utilisation and affordability of innovative anti-cancer medicines. However, the availability of innovative anti-cancer medicines in hospitals remained low and the utilisation of innovative anti-cancer medicines was affected by some factors, including the incidence of cancer, limitation of indications within the insurance program, and the rational use of innovative anti-cancer medicines. It is necessary to improve relevant supporting policies to promote the affordability of patients. The government should speed up the process of price negotiation to include more innovative anti-cancer medicines in the medical insurance coverage, consider including both medical examinations and adjuvant chemotherapy in the medical insurance, and increase investment in health care.

Metabolic syndrome and successful aging: A six‐year cohort study TIGER among community‐dwelling elderly in Taiwan

AbstractBackgroundMetabolic syndrome (MetS) has known to be associated with disability1, 2, cognitive impairment3 and depression4 in the older adults. However, the association between MetS and successful aging, an overall assessment of elders’ status, is unknown.MethodThis study is part of an ongoing prospective cohort study: Taiwan Initiatives for Geriatric Epidemiological Research (TIGER). A total of 605 participants (age 65+) were recruited at baseline (2011‐2013) with 4‐year and 6‐year follow‐ups. After exclusion of participants with missing data of successful aging and metabolic syndrome as well as loss to follow‐up, a total of 202 participants were included for statistical analysis. MetS was assessed at baseline (2011‐2013). Successful aging was evaluated at baseline, 4‐year and 6‐year follow ups. Successful aging was defined by the following variables: cognitive function, numbers of chronic disease, activity of daily living (ADL), instrumental activities of daily living (IADL), gait speed, depression, self‐rated health, the frequency of participating in social and leisure activities, the family support and annual disposable income. Generalized linear mixed‐effects models with random intercept were utilized to assess the association between MetS and successful aging adjusting for time (follow‐up years), age, sex, years of education, smoking, alcohol consumption and the interaction terms with time. A p value of &lt;0.05 (two‐tailed) for individual covariate and &lt;0.1 for interaction with time was considered statistically significant.ResultsAt baseline, 33.7% (n=68) older adults had MetS. Compared with older adults without MetS, those with MetS had lower diet quality (the modified Alternative Healthy Eating Index: 34.8 vs. 38.2), higher body mass index (25.7 vs. 22.9 kg/m2), higher mean serum C‐reactive protein level (0.26 vs. 0.17 mg/dL), and more chronic diseases [e.g., hypertension (70.6% vs. 30.6%), diabetes mellitus (27.9% vs. 2.2%), hyperlipidemia (70.6% vs. 35.1%) and cardiac disease (29.4% vs. 15.7%)]. The baseline MetS had a negative effect on the probability of successful aging, and the effect increased as time elapsed [MetS×time interaction: odds ratio=0.87, 90% confidence interval=0.76‐0.98, p‐value=0.06].ConclusionMetS is a risk factor of successful aging for community‐dwelling older adults. Prevention of MetS in earlier life will be beneficial to successful aging in their later life.

Attention deficit hyperactivity disorder and educational level in adolescent and adult individuals after anesthesia and abdominal surgery during infancy.

Several studies in animal models have found that exposure to anesthetics in early life can cause cognitive dysfunction. Human studies show conflicting results and studies of cognitive function after anesthesia and neonatal surgery are scarce. The aim of this study was to investigate whether exposure to anesthesia and abdominal surgery during infancy was associated with cognitive dysfunction from the perspective of educational level, disposable income and attention deficit hyperactivity disorders (ADHD) in adolescent and adult individuals. A cohort study with patients born 1976 to 2002 that underwent abdominal surgery during infancy at a pediatric surgical center were matched by age, sex, and gestational age to ten randomly selected individuals from the Swedish Medical Birth Register. Individuals with chromosomal aberrations were excluded. Data on highest level of education and annual disposable income were attained from Statistics Sweden and the diagnosis of ADHD were retrieved from the Swedish National Patient Register. 485 individuals and 4835 controls were included. Median gestational age was 38 weeks (24-44) and median age at surgery was seven days (0-365). Three hundred sixty-six individuals (70.0%) underwent surgery during the neonatal period (< 44 gestational weeks). Median operating time was 80 minutes (10-430). The mean age at follow-up was 28 years. Fisher's exact test for highest level of education for the exposed and unexposed groups were respectively: university 35% and 33%, upper secondary 44% and 47%, compulsory 21% and 20% (p = 0.6718). The median disposable income was 177.7 versus 180.9 TSEK respectively (p = 0.7532). Exposed individuals had a prevalence of ADHD of 5.2% and unexposed 4.4% (p = 0.4191). This study shows that exposure to anesthesia and abdominal surgery during infancy is not associated with cognitive dysfunction from the perspective of educational level, disposable income and ADHD in adolescent and adult individuals. Further studies in larger cohorts at earlier gestational ages are needed to verify these findings.

Association between regional economic status and renal recovery of dialysis-requiring acute kidney injury among critically ill patients

The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring AKI (AKI-D) is unknown. The nationwide prospective multicenter study enrolled critically ill adult patients with AKI-D in four sampled months (October 2014, along with January, April, and July 2015) in Taiwan. The regional economic status was defined by annual disposable income per capita (ADIPC) of the cities the hospitals located. Among the 1,322 enrolled patients (67.1 ± 15.5 years, 36.2% female), 833 patients (63.1%) died, and 306 (23.1%) experienced renal recovery within 90 days following discharge. We categorized all patients into high (n = 992) and low economic status groups (n = 330) by the best cut-point of ADIPC determined by the generalized additive model plot. By using the Fine and Gray competing risk regression model with mortality as a competing risk factor, we found that the independent association between regional economic status and renal recovery persisted from model 1 (no adjustment), model 2 (adjustment to basic variables), to model 3 (adjustment to basic and clinical variables; subdistribution hazard ratio, 1.422; 95% confidence interval, 1.022–1.977; p = 0.037). In conclusion, high regional economic status was an independent factor for renal recovery among critically ill patients with AKI-D.