China Health Statistics Yearbook Research Articles

Ranking the Healthcare Resource Factors for Public Satisfaction with Health System in China-Based on the Grey Relational Analysis Models.

(1) Background: Public satisfaction with the health system is a very important comprehensive indicator. Given the limited healthcare resources in a society, it is always important for policymakers to have full information about the priority and the ranking order of the factors of healthcare resources for improving public satisfaction. (2) Methods: Grey Relational Analysis (GRA) is advantageous for satisfaction analysis because satisfaction is a “grey concept” of “having a clear boundary but vague connotation”. The data were from the CGSS and the China Health Statistics Yearbook (2013 and 2015), with a total of 15,969 samples (average satisfaction score = 68.5, age = 51.9, female = 49.4%). (3) Results: The government’s percentage of total expenditure on healthcare was ranked as the most important factor for public satisfaction with the health system in China in both 2013 and 2015. The second most important factor changed from “Out-of-pocket percentage of individuals” in 2013 to “Hospital beds per thousand populations” in 2015. Meanwhile, “Healthcare workforce per thousand populations” increased from the least important factor in 2013 to the 3rd in 2015. Disparities in the ranking orders of the factors among regions of China were identified too. (4) Conclusions: The analysis results suggest that during recent years the priority of Chinese residents’ healthcare satisfaction for healthcare resources has shifted on the national level from economic affordability to more intensive “people-centered” services, while the regional disparities and gaps need to receive more attention and be further improved in the healthcare reform of next round.

The impact of regional income inequality on residents’ health in China

Since the reform and opening up, China’s economy has been developing, residents’ income has been increasing, people’s health awareness has also been building up, and the health situation has gradually improved. However, with the development of Chinese economy, the problem of income inequality also follows, which has an impact on the health of Chinese residents. In particular, the imbalance of regional economic development and the difference between urban and rural residents’ disposable income inequality have a negative impact on the health of residents, which is not conducive to sustainable economic development and social harmony and stability. This paper analyzes the correlation between regional income inequality and residents’ health status, uses descriptive statistical analysis and principal component analysis to do empirical analysis on the relationship between regional income inequality and residents’ health status, and selects the data from “China Health Statistics Yearbook 2019”. The results of empirical analysis show that regional income inequality has an impact on the health of residents in China. The health level of residents in high-income areas is higher than that in low-income areas. The economic development of the eastern and northern regions is better than that of the central and western regions, and the health status of the residents in the eastern and northern regions is better than that in the central and western regions. In addition, urban-rural income inequality also has an impact on the health of residents. The data show that the health status of urban residents is better than that of rural residents. It can be seen that there is a positive correlation between income level and residents’ health level, and a negative correlation between income inequality and residents’ health level. That is, the higher the income, the higher the health level of residents, the lower the income, the lower the health level of residents; the higher the degree of income inequality, the worse the health status of residents, and it is not conducive to the overall improvement of the health level of residents.

Development Trend of Infectious Disease Hospitals in China 2002-2018: A Longitudinal Analysis of National Survey Data.

BackgroundInfectious disease hospitals (IDHs) play very important roles in the battle against the infectious disease. The present study aims to systematically analyze the development trends and possible problems of IDHs in China.MethodsMost of the data came from the China Health Statistics Yearbook 2003–2019. Joinpoint Regression Model was used to analyze the development trends of IDHs between 2002 and 2018.ResultsFrom 2002 to 2018, the number of IDHs in China increased from 126 to 167, with an average annual percent change (AAPC) of 1.82%. The ratio of nurses to beds increased from 0.38 to 0.46 with the AAPC of 0.88%, and average business housing area per bed increased with an AAPC of 1.97%. The percentage of liabilities to total assets increased year by year and the percentage of medical business costs to total expenditure decreased. The segmented trend of daily visits per physician from 2014 to 2018 was stable, and the segmented trend of daily inpatients per physician from 2012 to 2018 decreased significantly. In 2017, the rates of surgical inpatients leaving the hospital without the doctor’s advice and surgical inpatients mortality were higher than 2016.ConclusionAlthough the development of IDHs was generally good in China, the scale of IDHs was generally small, the ability to respond to major emergencies was weak, the problem of irrational resource allocation was still prominent, and the operation of IDHs was facing a dilemma.

Analysis of Service Efficiency of Traditional Chinese Medicine (TCM) Hospitals in China Based on Data Envelopment Analysis (DEA)

In order to optimize the allocation of health resources and promote the development of traditional Chinese medicine (TCM), this research employs the China Health Statistics Yearbook 2018 to collect relevant data on TCM hospitals in 2017, and the DEA method is used to construct a BCC model for the evaluation of service efficiency of these hospitals in 30 provinces (including autonomous regions and municipalities directly under the central government) across the country. It is found that TCM hospitals in non-effective DEA provinces are not operating efficiently, with excessive investment in institutions, beds, and health staff, and insufficient output of visits, bed utilization, and the average length of stay. Given this, attention to promoting the service capacity and efficiency of TCM hospitals should be paid on the following aspects: scientific allocation of health resource, strengthened external policy control, improved internal management of hospitals, optimized characteristic services and establishment of scientific evaluation system.

Trends and challenges of emergency and acute care in Chinese mainland: 2005-2017.

Emergency medical service system (EMSS) is essential in providing acute care services for health conditions. However, trends of emergency and acute care in China haven't been studied systematically. Relevant literature was carefully reviewed, including original and review articles, letters, government reports, yearbooks, both in Chinese and in English. Data on the number of emergency visits, physicians and beds in emergency departments (EDs), and the workforce of pre-hospital emergency care were summarized and analyzed from China Health and Family Planning Statistical Yearbooks (2006-2018). Over the past decade, the number of ED visits tripled from 51.9 million to 166.5 million; and utilization of pre-hospital emergency care increased from 3.2 million to 6.8 million. In response to rapid increases in demand, the number of licensed emergency physicians raised from 20,058 to 59,409; the beds' number increased from 10,783 to 42,367. For pre-hospital emergency care, the volume of health workforce increased from 3,687 to 8,671, with a 109% increase in the number of physicians from 1,774 to 3,712. However, overcrowding, the long length of stay in EDs, poor work environment, and work exhaustion were still the critical challenges faced by China's EMSS. The number of emergency visits has grown with continual capability enhancement during the past decade. However, overcrowding, the long length of stay in EDs, poor work environment, and work exhaustion still need to be solved by China's EMSS. These findings and comparison with the USA could offer experiences and lessons to EMSS development worldwide, especially for developing countries.

Equity and Efficiency of Health Resource Allocation of Chinese Medicine in Mainland China: 2013-2017.

Background: In this study, we aimed to estimate the equity and efficiency of traditional Chinese medicine (TCM) health resource allocation, utilization, and trend in mainland China from 2013 to 2017.Methods: The data were downloaded from the China Health Statistical Yearbook (2014–2018) and the China Statistical Yearbook (2018). The equity of TCM health resource allocation was evaluated through the Lorenz curve, Gini coefficient (G), and Theil index (T) based on population size and geographical area. The efficiency and productivity of TCM health resource utilization were assessed using the data envelopment analysis-based Malmquist productivity index.Results: TCM health resource had an increasing trend every year. The equity allocated by population (G ranging from 0.1 to 0.3) was better than that by geographic region (G > 0.5). T in the intra-groups was higher than those in the inter-groups. The equity of TCM resource allocation was the middle region > eastern region > western region. Most provinces (29 out of 31) had negative productivity changes, suggesting deterioration in productivity. Moreover, the middle region with higher scale sizes had more redundant inputs than the other two regions. However, the low technological development (all technical values <1) might hinder productive progress.Conclusion: The equity of TCM health allocated by the population was better than that by the geographic region. The intra-regional difference was the main reason for inequity sources. Productivities in more than 97% of provinces are inefficient. The frequency distribution of scale efficiency (score > 1) had increased since 2015. However, the frequency distribution of technical change (score > 1) decreased every year. The slow technological progress and low scale size might be the main reasons for low productivity.

The Current Situation and Future Trend of Leukemia Mortality by Sex and Area in China.

Leukemia is one of the most common cancers. We conducted this study to comprehensively analyze the temporal trends of leukemia mortality during 2003–2017 and project the trends until 2030. We extracted national-level data on annual leukemia mortality from China Health Statistics Yearbooks (2003–2017). We applied the Joinpoint regression model to assess leukemia mortality trends in urban and rural China by sex during 2003–2017. We also produced sex-specific leukemia mortality using the adjusted Global Burden Disease (GBD) 2016 projection model. In urban areas, age-standardized leukemia mortality decreased significantly among females during 2003–2017 (APC = −0.9%; 95% CI: −1.7, −0.1%). In rural areas, significant decreases of age-standardized leukemia mortality were both found among males (APC = −1.7%; 95% CI: −2.9, −0.5%) and females (APC = −1.6%; 95% CI: −2.6, −0.7%) from 2008 to 2017. Rural-urban and sex disparities of leukemia mortality will continue to exist until the year 2030. According to projection, the leukemia mortality rates of males and rural populations are higher than that of females and urban populations. In 2030, leukemia mortality is projected to decrease to 3.03/100,000 and 3.33/100,000 among the males in urban and rural areas, respectively. In females, leukemia mortality will decrease to 1.87/100,000 and 2.26/100,000 among urban and rural areas, respectively. Our study suggests that more precautionary measures to reduce leukemia mortality are need, and more attention should be paid to rural residents and males in primary prevention of leukemia in China.

Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals

ABSTRACT As China’s health system is faced with challenges of overcrowded hospitals, there is a great need to better understand the recent patterns and determinants of people’s choice between primary care facilities and hospitals for outpatient care. Based on recent individual-level data from the China Health and Retirement Longitudinal Survey (CHARLS) and official province-level data from China health statistical yearbooks, we examine the patterns of outpatient visits to primary care facilities versus hospitals among middle-aged and older individuals and explore both supply- and demand-side correlates that explain these patterns. We find that 53% of outpatient visits were paid to primary care facilities as opposed to hospitals in 2015, compared to 60% in 2011. Both supply and demand factors were associated with this decline. On the supply side, we find that the density of primary care facilities did not account for this decline, but higher densities of hospitals and licensed doctors were associated with lower use of primary care facilities. On the demand side, we find that individuals with higher socioeconomic status and greater health care needs were less likely to use primary health care facilities. Our findings suggest that a high concentration of health care professionals in hospitals diverts patients away from primary care facilities. Staffing the primary care facilities with a well-trained health care workforce is the key to a well-functioning primary care system. The findings also suggest a need to address demand-side inequality issues.

The impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China

BackgroundSince 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making.MethodsThe Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018.ResultsThe reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures.ConclusionWe conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).

Disease burden of liver cancer in China: an updated and integrated analysis on multi-data source evidence

Objective: To analyze the disease burden of liver cancer in China. Methods: Based on eight data sources, including the series of Chinese Cancer Registry Annual Report, three national death cause surveys in China, China Health Statistical Yearbook, China Death Cause Surveillance Datasets, GLOBOCAN, Cancer Incidence in Five Continents (CI5), WHO Mortality Database and the Global Burden of Disease (GBD), the information on incidence, mortality and disability-adjusted life year (DALY) of liver cancer, were extracted for the analysis on the past, current and future disease burden caused by liver cancer in China. Results: 1) Past situation: The long-term data from 1973 to 2012 reported by the CI5 showed that in urban populations in China (taking Shanghai as an example), the incidence rate of liver cancer in males and females decreased by 41.3% and 36.3%, respectively, and that in rural areas (taking Qidong as an example) decreased by 32.3% and 12.2%, respectively. The Chinese Cancer Registry Annual Reports showed that the national incidence and mortality rates of liver cancer decreased by 8.1% and 12.8% respectively from 2005 to 2015. The Joinpoint analysis based on the data from the China Health Statistics Yearbook also showed a declining trend: the average annual percentage change of liver cancer mortality in China from 2002 to 2017 was -3.0% (P<0.05), and that in rural areas was -3.1% (P<0.05). 2) Current status: GLOBOCAN estimates that the rates of incidence, mortality and prevalence of liver cancer in China in 2018 were 18.3 per 100 000, 17.1 per 100 000 and 10.8 per 100 000, respectively. According to the latest annual report, the incidence and mortality rates of liver cancer in cancer registration areas in 2015 were 17.6 per 100 000 and 15.3 per 100 000, respectively, and both increased with age. The mortality rate was similar to that reported in 2017 (16.7 per 100 000) by the China Death Cause Surveillance Datasets, and the male to female ratio of live cancer deaths was estimated as 3.1. The GBD 2017 reports that the DALYs caused by liver cancer in China reached 11 153.0 thousand in 2017 (accounting for 53.7% of the global DALYs) and hepatitis B virus infection was always the leading cause. 3) Prediction: The GLOBOCAN 2018 predicts that, by 2040, the number of liver cancer cases and deaths in China would reach 591 000 and 572 000 (with an increase of 50.5% and 54.9%, respectively, compared with those in 2018), with a more significant increase in people over 70 years old. 4) Economic burden: According to the literature review of economic burden data on liver cancer, the direct medical expenditure per patient with liver cancer generally showed a rising trend. Conclusions: Multiple data sources indicate that the incidence and mortality rates of liver cancer in populations in China decreased in the past decades, indicating the effect of population interventions. However, the population-level disease burden are still substantial, and comprehensive intervention strategies need to be continually strengthened and optimized, especially the primary and secondary prevention.

Health workforce and health-related sustainable development goals from 1990 to 2018 in China: a retrospective study based on national statistical data

BackgroundThe health workforce has vital roles in protecting and promoting the health of the population, given that it is a prerequisite of health care. Reducing maternal mortality, neonatal mortality, and under-5 mortality are three important health-related sustainable development goals (SDGs). To my knowledge, no study has yet analysed the importance of the health workforce for health-related SDGs in China on the basis of multiple-year national statistical data. I aimed to achieve this with the present study. MethodsUnivariate linear regression analyses were done with maternal mortality ratios, neonatal mortality, and under-five mortality as dependent variables. Aggregate density of health technicians was an independent variable in one set of regressions. Doctor and nurse densities were separately used in two other sets. All variables were transformed into natural logarithms. Statistical data for these variables covered 1990–2018 and were extracted from the China Health Statistics Yearbook 2019, WHO, and the UN Inter-agency Group for Child Mortality Estimation. The study was approved by the ethics committee of the School of Medicine of Xi’an Jiaotong University (number 2014189). FindingsDensity of health technicians was significant in accounting for maternal mortality ratio, neonatal mortality, and under-5 mortality (with elasticities ranging from –1·219 to –2·400, all p-values <0·0001). The elasticities of the three types of mortality with respect to doctor and nurse densities ranged from –1·643 to –3·227 (p=0·00012 for maternal mortality ratio, p<0·0001 for neonatal mortality, and p<0·0001 for under-5 mortality) and from –0·766 to –1·471 (all p-values <0·0001). InterpretationThe density of the health workforce is important in accounting for variation in maternal mortality ratio, neonatal mortality, and under-5 mortality in China. The effect of this density in reducing child mortality is greater than it is in reducing maternal mortality in China, possibly because qualified health technicians can better address the illnesses that put children at risk. Doctor density has a greater effect than nurse density in reducing all the three mortality types, possibly because of a greater of specialisation of doctors. Investment in the health workforce should always be part of a strategy to achieve health-related SDGs in China. FundingMajor Programme of National Social Science Fund of China: Research on Disease Prevention and Healthy China Construction (17ZDA079).

Trend in age-specific cancer mortality and cancer-free life expectancy in China, 2008–17: a cross-sectional survey of nationwide data

BackgroundCancer is the main chronic disease that affects the health of Chinese residents; however, there have been few systematic studies on cancer-free life expectancy in China. We aimed to explore age-specific cancer mortality and changes in population lifespan after accounting for the removal of the burden of cancer to provide important insights and a basic reference on the development of relevant health policies, such as cancer control or elderly care. MethodsWe used population data from the National Bureau of Statistics and data on cancer mortality from the China Health Statistics Yearbook to produce estimates of the number of deaths from 2008 to 2017 for 18 different age groups, female and male individuals, urban areas and rural areas, and different cancer types. We analysed the change in mortality for the 18 different age groups from 2008 to 2017 and inputted the population mortality and deaths caused by cancer into a life table system to calculate life expectancy for all age groups and cancer-free life expectancy for all age groups. FindingsFrom 2008 to 2017, total mortality associated with cancer in China decreased at a steady trend per year in urban areas and increased in rural areas. Mortality of the various age groups decreased during the 10-year period, whereas overall mortality rate increased due to population ageing. Lung cancer in rural areas increased by 2·8% (SD 1·2–4·4) per year, and liver cancer and stomach cancer significantly decreased by 2·1–2·2% per year in rural areas (p<0·0001). Life expectancy of the entire population increased from 74·6 years in 2008 to 75·6 years in 2017. Life expectancy in women (77·5–78·4 years) was higher than in men (72·0–73·1 years) from 2008 to 2017, and life expectancy in urban areas (76·0–76·2 years) was higher than rural areas (73·1–75·0 years). After removing the effects of cancer, life expectancy of the total population increased by about 3 years. Lung cancer had a greater effect on life expectancy than other types of cancer, and predominantly affects the male population younger than 54 years. If cancer were to be effectively controlled, the life expectancy of the population aged 50–84 years would be significantly improved. InterpretationCancer is a serious disease that harms the health of the population in China. The development of medicine is the main reason for the rapid increase in life expectancy in rural areas. Increased smoking and obesity are the main factors affecting the life expectancy of the Chinese population, although the development of new drugs and some new vaccines can effectively control cancer deaths. The study of life expectancy and healthy life expectancy will be important topics of research in the future. FundingNational High-tech R&D Program (863 Program) for High-end Electronic Medical Record Technology Development and System Application Demonstration (2012AA02A607).

Disease burden of colorectal cancer in China: any changes in recent years?

Objective: To update the disease burden of colorectal cancer (CRC) in Chinese population by integrating the latest multi-source evidences. Methods: Groups of data from GLOBOCAN, series of Chinese Cancer Registry Annual Report (annual report), Cancer Incidence in Five Continents (CI5), Global Burden of Disease Project 2017 (GBD), China Death Cause Surveillance Datasets and China Health Statistical Yearbooks (yearbook) were used to extract the information. Data on incidence, mortality, disability-adjusted life year (DALY) and percentage distribution of sub-location of CRC were used to analyze the latest disease burden in China, and age-standardized rates by world standard population were mainly used. Joinpoint Trend Analysis Software 4.7.0.0 was applied for time trend analysis. Data related to the economic burden of CRC in China were gathered by literature review. Results: (1) Current status: according to the latest annual report, the incidence and mortality rates of CRC were 17.1 per 100 000 and 7.9 per 100 000, respectively among the covered registration sites in 2015. The incidence ratios of male to female and that of urban to rural were 1.5 and 1.4, with the mortality ratios were 1.6 and 1.4, respectively. Similar to data from the annual report, the mortality rate was reported as 6.9 per 100 000 in 2017 by the surveillance data sets. Data from the GBD project showed that, the DALYs caused by CRC in China in 2017 was 4.254 million person years (doubled compared with that of 1990), accounting for 22.4% of the global burden of CRC. (2) Time trends: according to the annual reports, from 2009 to 2015, the incidence rate and mortality rate of CRC in China decreased by 10.2% and 9.5%, respectively. The same trend was also observed in urban sites, but was opposite in rural areas (increased 20.0% in incidence and 15.2% in mortality). Results from the Joinpoint analysis showed that the averaged annual percentage change (AAPC) was estimated as -1.6% (P<0.05) in the national mortality rate. Similarly, in the incidence and mortality rates of urban sites appeared as AAPC=-1.5% and -1.4% (all P<0.05), but inversely in the incidence rate from the rural sites as AAPC=3.3% (P<0.05). The yearbook data showed a 9.8% increase in urban and 20.6% increase in rural on the mortality in 2017 when compared with 2004, but the Joinpoint analysis showed no statistical significance (P<0.05). (3) Distribution of sub-location of CRC: the annual report showed that among all the new CRC cases in China in 2015, colon, rectal and anal cancer accounted for 49.6%, 49.2% and 1.2%, respectively, while the proportions were 51.3%, 47.6% and 1.1%, respectively in 2009. The proportion of colon cancer was continuously higher in the urban (>52%) than that in the rural areas (<44%). The CI5 Ⅺ data showed that ascending and sigmoid colons were more commonly seen among all the colon cancers. (4) Economic burden: the average annual growth rate of the medical expenditure per CRC patient in China ranged from 6.9% to 9.2%, and the 1-year out-of-pocket expenditure of a newly diagnosed patient accounted for about 60% of their previous-year household income. Conclusions: In China, the overall disease burden of CRC might have been decreased slightly but generally remained stable in the last several years, however, the rising burden appeared in the rural areas should not be ignored. In consistent with findings from a previous review, men and people from the urban areas are considered the target populations for CRC. The finding of higher proportion of colon cancer in urban areas suggests the impact of development of socioeconomic and medical technologies on CRC development and detection. The economic burden of CRC continued to grow.

Current situation and distribution equality of public health resource in China

BackgroundThe public health system has been developed in China for several years while no research explores its distribution. This research aims to describe the variation and equality of public health allocation from 2013 to 2018 and explore the source of inequality.MethodsData in this research was obtained from the China Health Statistics Yearbook 2014 to 2019 and the China Statistical Yearbook 2019. Four indicators were chosen in describing the development and current situation of the public health system. Three of them were used to evaluate allocation equality. 31 provinces were categorized into western, middle, and eastern groups based on geographical and economic conditions. Total allocation equality, inter- and intra-difference were all measured by the Theil index.ResultsAll indicators showed a stably upwards trend except for the number of public health institutions. The allocation gap of the public health institution per km2 was larger than that per 10,000 capita. Theil index of three indicators continually rose from 2013 to 2018 and the inequality of public health institutions allocation was the highest one. The western region had the highest Theil index in technical personnel and beds allocation. Among the three regions, the western region contributed most to inequality.ConclusionsThe public health workforces and institutions are still under the requirement of the National Medical and Health Service System Plan. From 2013 to 2018, the equality of public health resources stably decreases, which is mainly contributed by the internal difference within the western region. Further research should be done to explore the possible cause of the results. Problems founded in this research should be solved by multisectoral cooperation.

Urban-rural divide in foodborne illness in China: what can we learn from the socioeconomic factors?

Background China’s urban-rural divide, though still improving, can be seen from various sectors of the economy. The objective of this study is to explore how socioeconomic factors in and across both urban and rural areas explain the occurrence of foodborne illness in China. Over the last decades, food safety laws and regulations have been established in China, but more understanding about the food safety issues are needed in order to eliminate food safety hazards. Methods This study intends to estimate several panel data models in econometrics to obtain the average partial effects of many socioeconomic factors in and across urban and rural areas on per capita foodborne incidents and patients, respectively. Given the fractional nature of the two dependent variables, fractional probit models are estimated using both the Quasi Maximum Likelihood Estimation (QMLE) and the bootstrap Generalized Estimating Equations (GEE) approaches in addition to the standard estimation of panel data random effects, fixed effects, and Tobit models. China official data on foodborne incident and patient cases in each province and in each year from 2011 to 2018 are obtained from various issues of the China Health Statistical Yearbook. Additional data on 19 socioeconomic variables are obtained from various issues of the China Statistical Yearbook. Results The main results show that socioeconomic factors such as owning TVs, owning refrigerators, consumption expenditures and household income in urban or rural areas explain the per capita foodborne incidents or per capita foodborne patients differently, reflecting differences in people’s food safety awareness, food storage patterns, food markets, and income effects in the urban and rural areas. Socioeconomic factors such as urbanization and primary industry’s share of the gross regional product across areas tend to worsen the food safety problem. Improving regional economies and increasing government spending on public health could reduce the occurrence of foodborne illness. Conclusions It is suggested that governments take into account the social disparities of urban and rural areas when designing and implementing food safety policies. It is also suggested that a holistic approach is needed to resolve food safety issues by combining food safety control and management policies with soil and water management policies.

National and Subnational Trends in Mortality and Causes of Death in Chinese Children and Adolescents Aged 5–19 Years From 1953 to 2016

PurposeWe aimed to analyze the recent trends of mortality and rankings of causes of death in Chinese children and adolescents from 1953 to 2016. MethodsData on mortality and causes of death in Chinese children and adolescents aged 5–19 years were extracted from the China Health Statistics Yearbook and the Global Burden of Disease Study from 1953 to 2016. Mortality variations were analyzed by year, age, sex, province, and causes of death. ResultsThe mortality of Chinese children and adolescents aged 5–19 years declined steadily from 1953 (366.03/100,000) to 2016 (27.21), with the largest reduction in adolescents aged 15–19 years and the smallest reduction in those aged 10–14 years. Large subnational disparities for all-cause mortality existed in national 31 provinces with higher mortality in western regions compared with eastern regions, but with narrowing disparities between 1981 and 2010. Injuries dominated the causes of death compared with noncommunicable diseases and communicable, maternal and neonatal, and nutritional diseases from 1990 (58.13/100,000 vs. 32.10 and 14.31) to 2016 (22.65 vs. 13.00 and 2.93). In 2016, the leading three causes of death were road injuries (8.30/100,000), drowning (7.25), and leukemia (2.60). Drowning was the leading cause of death for 5- to 14-year-olds, but road injuries have been the leading cause for 15- to 19-year-olds of both sexes since 2010. ConclusionsAlthough mortality in Chinese adolescents now stands at just 7% of rates in the 1950s, there is a need to address continuing inequalities across sex, economic status, and region.

Level and trend of respiratory diseases mortality in China from 2002 to 2016

Objective: To analyze the level and trend of respiratory disease mortality in China from 2002 to 2016. Methods: The standardized mortality rates were calculated based on the China health statistics yearbook (2003-2012) and China statistical yearbook of health and family planning (2013-2017) data released by the statistical information center of National health Commission of the People's Republic of China. Joinpoint model was used to calculate the standardized mortality rates (SMR), Annual percentage change (APC) and the average annual percentage change (AAPC) for standardized mortality rates. Results: The SMR of respiratory diseases and chronic lower respiratory diseases were decreased significantly in 2002 to 2016 (AAPC=-3.6%, AAPC=-6.4%, P<0.001, respectively). The SMR of lung cancer showed a significant increase trend (AAPC=1.6%, P=0.001). There were no significant differences in the SMR of pneumonia and pneumonoconiosis (APCC=1.0%, P=0.242; APCC=-0.2%, P=0.905). Both urban and rural SMR of respiratory diseases were declining significantly (AAPC=-2.9%, P=0.001; AAPC=-4.2%, P<0.001). Both urban and rural SMR of lung cancer showed an increasing trend (AAPC=0.6%, P=0.022; AAPC=2.1%, P=0.003, respectively). The SMR of pneumonia in urban areas showed an upward trend (AAPC=2.7%, P=0.017). The SMR of respiratory disease of all age groups (<35 years old, 35-65 years old and ≥65 years old) showed a downward trend (AAPC=-3.8%, P=0.001; AAPC=-2.6%, P<0.001; AAPC=-3.9%, P<0.001). The SMR of pneumonia between 35 and 65 years old and SMR of lung cancer over 65 years old showed an increasing trend (AAPC=2.8%, P=0.001; AAPC=2.4%, P<0.001). The SMR of respiratory diseases among males and females showed a downtrend (AAPC=-3.1%, P<0.001; AAPC=-4.3%, P<0.001). However, the SMR of lung cancer in males and females increased significantly (AAPC=1.2%, P<0.001; AAPC=2.5%, P<0.001, respectively). There were no significant trends in the SMR of pneumonia and pneumoconiosis in males (AAPC=1.5%, P=0.096; AAPC=-1.6%, P=0.218). There was no obvious trend in the SMR of pneumonia in females (AAPC=-0.1%, P=0.872). Conclusions: The SMR of respiratory diseases in China generally shows a downward trend. The overall SMR and SMR of major respiratory diseases varies among different regions, genders and age groups.

Achieving SDG related sexual and reproductive health targets in China: what are appropriate indicators and how we interpret them?

BackgroundSexual and Reproductive Health (SRH) targets have been included as part of the United Nations Sustainable Development Goals and indictors are important to monitor progress towards these targets. SRH indicators are recommended for setting norms and measuring progress globally. However, given the diverse political, socioeconomic and cultural contexts in different countries, and lack of global agreement on broad indicators, it is important to select appropriate indicators for specific countries. Based on internationally recommended indicators and data availability in China, this paper selected four indictors to reflect SRH in China and interpreted these indictors by analyzing the underlying factors.MethodsWe employed secondary data analysis and key informant interviews. Secondary data were obtained from the China Health Statistical Yearbook (2005–2017), China Statistical Yearbook (2005–2017), and the sub-national estimates of the Global Burden Diseases Study 2016. We interviewed 36 key informants at national and sub-national levels.ResultsThe four selected SRH indicators are contraceptive prevalence rate (CPR), adolescent birth rate, abortion rate, and availability of school sex education. CPR of married women has remained above 75% over the last three decades, indicating a high level of access to family planning (FP) services; however, unmarried but sexually active women have significant unmet needs for FP services. Although adolescent birth rates in China remain low, the abortion rate, abortion numbers, and the ratio of abortions to births increased from 2014 to 2016 while FP policy was relaxed. This suggests that abortion among unmarried women is a significant contributor to overall figures. Qualitative analysis of the availability of school sex education, reveals an absence of policy due to conservative attitudes of key stakeholders.ConclusionSince SRH challenges vary significantly between contexts, indicators for measuring progress towards SRH targets should be selected based on country context. The CPR and abortion rate are currently available and important indicators to monitor the most basic part of SRH in China, but require modification to ensure they reflect universal access to quality reproductive healthcare by all reproductive age women, regardless of their marriage status. Policy and indicators on sex education need to be carefully developed to fit the context in China.

Anatomy of provincial level inequality in maternal mortality in China during 2004\u20132016: a new decomposition analysis

BackgroundThe maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016.MethodsWe collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values.ResultsDuring our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality.ConclusionAccess to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.

PCV21 COST-EFFECTIVENESS ANALYSIS OF PLUS ASPIRIN VS PLACEBO PLUS ASPIRIN IN THE TREATMENT OF ISCHEMIC STROKE BASED ON A RANDOMIZED CLINICAL TRIAL

Stroke is the leading cause of death and long-term disability in China with high-incidence, high-mortality and heavy-disease-burden. In addition to the chemical drugs, Chinese guidelines for diagnosis and treatment of acute ischemic stroke recommends the application of Chinese patent medicines. Ginkgolide injection is commonly used in the clinical treatment of stroke in China for its effect in promoting blood circulation and removing blood stasis, clearing channels and activating collaterals. A GISAA RCT study evaluated the efficacy and safety between Ginkgolide plus Aspirin and Placebo plus Aspirin. This study intends to evaluate the long-term cost-effectiveness of Ginkgolide plus Aspirin compared with placebo plus Aspirin based on the RCT results and literature. A Markov model is constructed consisting 4 states: No significant disability, Disability, Stroke recurrence and Death. Therapeutic data is from GISAA study. Utilities, transition probabilities are extracted from literatures. Costs data is from China Health Statistics Yearbook and hospital record survey. Expected costs and QALYs of 13 years’ circles (Calculated by average age of subjects and Chinese life expectancy) are calculated through TreeagePro11 software. The WTP threshold is the Chinese per capita GDP in 2018, ￥64644/QALY. The results are analyzed by single factor and probability sensitivity analysis. Ginkgolide plus Aspirin is found to have higher expected per-patient cost than placebo plus Aspirin, but also higher QALYs. Compared to placebo plus Aspirin, Ginkgolide plus Aspirin produces an incremental cost effectiveness ratio of ￥14920.17/QALY, which is below the WTP threshold. Probabilistic sensitivity analysis suggests that the acceptability of Ginkgolide plus Aspirin is higher than that of placebo plus Aspirin. The cost-effectiveness analysis based on RCT shows that the addition of ginkgolides to conventional treatment is cost-effective at the threshold of Chinese per capita GDP.