China National Health Research Articles

Development and application of ex-ante performance evaluation framework for health projects in China

China National Health Commission issued an implementation plan for budget performance management in health projects in April 2021, which emphasizes all health projects must be evaluated in advance prior to implementation. The study aims to develop an ex-ante performance evaluation framework for health projects and formulate a self-assessment report template. The study also attempts to gain insights into the ex-ante performance of health projects in China, identify issues and explore the factors that influence the ex-ante performance of health projects and make suggestions about improvement strategies. The framework was established by using a framework development methodology. To develop the framework, the findings from existing research were pooled and organized to create indicators and key points. The preliminary ex-ante performance evaluation framework was refined, validated and tested by the experts. Weight analysis was conducted by using the Analytic Hierarchy Process. Then the indicator system has been transformed into a project ex-ante performance self-assessment report template. Samples of 698 municipal health projects in China from 2021 to 2022 were analyzed. We invited experts to complete the scoring task by using our ex-ante performance evaluation framework. The ex-ante performance evaluation framework primarily examines five aspects, the necessity of the project, economy of input, rationality of performance indicators, feasibility of implementation plans, and compliance of financing. The overall ex-ante performance evaluation score for the sample projects was (91.19 ± 8.02). The sub-scores for necessity of project were (14.74 ± 1.85), economy of input was (34.45 ± 2.43), reasonableness of performance indicators was (8.27 ± 2.28), feasibility of implementation plan was (23.99 ± 3.84), and compliance of financing was (9.75 ± 1.47). Factors such as whether it was an epidemic prevention and control project, the project budget, project content, project objective, and project implementation organization were all influencing the ex-ante performance of health projects (P < 0.05). We have developed a ex-ante performance evaluation framework for health projects and established a project ex-ante performance self-assessment report template. They can offer a sufficient reference for project process management. Project implementation organization should elevate the awareness and proficiency of project managers regarding budget performance management. Government should improve the ability of ex-ante performance evaluation, and eliminate ineffective projects through ex-ante performance evaluation.

Electronic senses and UPLC-Q-TOF/MS combined with chemometrics analyses of Cynanchum species (Baishouwu).

Baishouwu, derived from Cynanchum auriculatum (CA) Royle ex Wight, Cynanchum bungei (CB) Decne., and Cynanchum wilfordii (CW) (Maxim.) Hemsl., is a valuable traditional Chinese medicine. CA is also recognized as a new food resource by China's National Health Commission. Given the considerable variations in flavor and chemical composition among these species and lack of their qualitative assessments, accurately differentiating between the species constituting Baishouwu is essential. To develop a method combining electronic tongue (E-tongue), electronic nose (E-nose), and ultra-performance liquid chromatography-quadrupole-time of flight/mass spectrometry (UPLC-Q-TOF/MS) to differentiate between Baishouwu samples. Fifteen batches of Baishouwu samples were analyzed using E-tongue, E-nose, and UPLC-Q-TOF/MS. Flavor differences and key differential metabolites were determined through principal component analysis and orthogonal partial least squares discriminant analysis. E-tongue results revealed umami, sweetness, and richness as the predominant flavors of Baishouwu, with CA having the highest umami response, CW exhibiting the highest bitterness, and CB the highest sweetness. E-nose sensors showed consistent responses across species, with variations in signal strength; W1W and W2W sensors showed the highest response values. A total of 158 and 41 characteristic variables in the positive and negative ion modes, respectively, were selected as candidate differential metabolites, of which 29 and 14 were confirmed through database comparison. Eight critical differential metabolites, including C21 steroids and acetophenone compounds, were identified. This study presents a strategy for differentiating among the species constituting Baishouwu, providing a basis for broader application and establishing quality standards for these medicinal compounds.

Sex-specific associations between total and regional Fat-to-muscle Mass ratio and cardiometabolic risk: findings from the China National Health Survey

BackgroundThe fat-to-muscle mass ratio (FMR), integrating the antagonistic effects of fat and muscle mass, has been suggested as a valuable indicator to assess cardiometabolic health independent of overall adiposity. However, the specific associations of total and regional FMR with cardiometabolic risk are poorly understood. We aimed to examine sex-specific associations of total and regional FMR with single and clustered cardiometabolic risk factors (CRFs).Methods13,505 participants aged 20 years and above were included in the cross-sectional study. Fat mass and muscle mass were assessed using a bioelectrical impedance analysis device. FMR was estimated as fat mass divided by muscle mass in corresponding body parts (whole body, arm, leg, and trunk). Clustered CRFs was defined as the presence of two or more risk factors, including hypertension, elevated blood glucose, dyslipidemia, insulin resistance (IR), and hyperuricemia. IR was assessed by the triglyceride glucose (TyG) index. Multivariable logistic regression models were applied to explore the associations of FMR in the whole body and body parts with single and clustered CRFs.ResultsThe odds ratios (ORs) increased significantly for all single and clustered CRFs with the per quartile increase of total and regional FMR in both sexes (P for trend < 0.001), following adjustment for confounders. Among the regional parts, FMRs of the legs presented the strongest associations for clustered CRFs in both men and women, with adjusted OR of 8.54 (95% confidence interval (CI): 7.12–10.24) and 4.92 (95% CI: 4.24–5.71), respectively. Significant interactions (P for interaction < 0.05) were identified between age and FMRs across different body parts, as well as between BMI status and FMRs in different regions for clustered CRFs. Restricted cubic splines revealed significant non-linear relationships between FMRs of different body parts and clustered CRFs in both sexes (P for nonlinear < 0.05).ConclusionsFMRs in the whole body and different regions were significantly associated with single and clustered CRFs in the general Chinese population. The association between FMR and clustered CRFs was more pronounced in youngers than in the elderly.

Prevalence and risk factors for refractive error in older adults in eight ethnicities in China: The China national health survey

PurposeThis study aimed to investigate the prevalence of refractive error (RE) and risk factors for myopia among older adults in the Han and various minority ethnic groups across seven provinces in China. MethodsThis cross-sectional study forms a part of the ophthalmic dataset of the China National Health Survey (CNHS). Face-to-face interviews and ophthalmic examinations were conducted in seven provinces located in western and northern China. The age- and sex-adjusted prevalence of RE among Han and seven other ethnic groups aged 50–80 years were compared. A mixed-effects model was used to identify the risk factors associated with RE. ResultsA total of 12,902 participants, including 8800 Han and 4102 from ethnic minorities, were included in the study. The age- and sex-adjusted prevalence of myopia, high myopia, hyperopia, and astigmatism ranged from 15.3 % (Manchu) to 22.9 % (Han), 0.2 % (Yugur) to 2.8 % (Han), 21.6 % (Tibetan) to 48.9 % (Uyghur), and 38.7 % (Yi) to 57.5 % (Manchu) across different ethnicities, respectively. Compared to the Han population, the Mongolian (odds ratios (OR) 0.62, 95 % confidence interval (CI) 0.46–0.84, p = 0.002), Tibetan (OR 0.66, 95 % CI 0.52–0.85, p = 0.001), Uyghur (OR 0.63, 95 % CI 0.49–0.80, p < 0.001), Yi (OR 0.65, 95 % CI 0.46–0.92, p = 0.014), and Yugur (OR 0.65, 95 % CI 0.50–0.85, p = 0.001) ethnicities were less likely to have myopia. There was no significant difference in the prevalence of myopia between the Manchu, Korean, and Han ethnic groups. Factors associated with a lower prevalence of myopia included rural residence (p < 0.001), a body mass index (BMI) > 18.5 kg/m2 (all p < 0.001), residence in higher latitude areas (p = 0.020), and a history of smoking (p = 0.002 in the past smoking group, p = 0.031 in the current smoking group). The Mongolian (p = 0.006) and Yugur (p = 0.007) populations, participants living in rural areas (p = 0.012), and those with a BMI >24 kg/m2 (p = 0.038 in the >24.0 ≤ 27.0 kg/m2 group or p = 0.041 in the >27.0 kg/m2 group) were less likely to have high myopia. Factors associated with a higher prevalence of hyperopia included older age (all p < 0.001), rural residence (p = 0.039), higher latitude areas (p = 0.031), smoking history (p = 0.040), and Mongolian (p = 0.001), Uyghur (p < 0.001), Yi (p < 0.001), and Yugur (p = 0.002) ethnicities. Conversely, the Manchu population (p = 0.004) and individuals with higher education levels than illiteracy (p = 0.024 or p < 0.001) were less likely to have hyperopia. ConclusionsMyopia affected more than one-fifth of the older adults in the Han population in this survey. Significant differences in the prevalence of RE were observed between minority ethnicities and Han individuals, except for the Manchu and Korean groups.

Associations of muscle mass, strength, and quality with diabetes and the mediating role of inflammation in two National surveys from China and the United states

AimsThe evidence for joint and independent associations of low muscle mass and low muscle strength with diabetes is limited and mixed. The study aimed to determine the associations of muscle parameters (muscle mass, strength, quality, and sarcopenia) and sarcopenia obesity with diabetes, and the previously unstudied mediating effect of inflammation. Materials and MethodsA total of 13,420 adults from the 2023 China National Health Survey (CNHS) and 5,380 adults from the 2011–2014 National Health and Nutrition Examination Survey (NHANES) were included in this study. Muscle mass was determined using bioelectrical impedance analysis (BIA) in the CNHS, and whole-body dual X-ray absorptiometry (DXA) in the NHANES. Muscle strength was assessed using digital hand dynamometer. Multivariate logistic regression models were used to evaluate the associations of muscle parameters and sarcopenia obesity with diabetes. Inflammatory status was assessed using blood cell counts and two systemic inflammation indices (platelet-to-lymphocyte ratio (PLR) and system inflammation response index (SIRI)). Mediation analysis was conducted to examine inflammation’s role in these associations. ResultsLow muscle mass and strength were independently related to diabetes. Low muscle quality was associated with elevated diabetes risk. Sarcopenia has a stronger association with diabetes compared to low muscle strength alone or mass alone (CNHS, odds ratio (OR) = 1.93, 95 % confidence interval (CI):1.64–2.27; NHANES, OR = 3.80, 95 %CI:2.58–5.58). Participants with sarcopenia obesity exhibit a higher risk of diabetes than those with obesity or sarcopenia alone (CNHS, OR = 2.21, 95 %CI:1.72–2.84; NHANES, OR = 6.06, 95 %CI:3.64–10.08). Associations between muscle parameters and diabetes were partially mediated by inflammation (mediation proportion: 1.99 %-36.64 %, P < 0.05). ConclusionLow muscle mass and muscle strength are independently or jointly associated with diabetes, and inflammation might be a potential mechanism underlying this association. Furthermore, the synergistic effects of sarcopenia and obesity could significantly increase diabetes risk.

Association between sedentary behavior, screen time and metabolic syndrome among Chinese children and adolescents

BackgroundThe aim of the study was to investigate the relationship between sedentary behavior, screen time and MetS among Chinese children and adolescents aged 7–17 years. Data was obtained from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017.MethodsData on sedentary time, screen time, and MetS indicators were obtained through physical and health questionnaires, anthropometric measurements, and clinical examinations. MetS was defined according to the Cook’s criteria. Wilcoxon rank sum test and chi-square test were applied for comparisons of measurement data and counting data, respectively. The relationship between sedentary time, screen time, and MetS and its components was analyzed using a multivariate logistic regression model.ResultsThe prevalence of MetS among 7-17-year-old students in 2016–2017 was 5.45%. Compared to those with low sedentary behavior, in high sedentary behavior groups, the prevalence of abdominal obesity, high TG, low HDL-C, and MetS was high in boys, and the prevalence of abdominal obesity, high TG, hyperglycemia, and MetS was high in girls. Moreover, for those who reported ≥ 3 h/day of screen time, the prevalence of abdominal obesity, low HDL-C, and MetS was higher in boys, and the prevalence of abdominal obesity and MetS was higher in girls. After adjusting for confounding variables, the risks of abdominal obesity, high TG, low HDL-C, and MetS were higher in high-level sedentary time group, and the risks of abdominal obesity and MetS were 1.15 and 1.14 times higher for those who spent ≥ 3 h/day on screen time, respectively.ConclusionsThis study shows that high levels of sedentary time and screen time were associated with an increased likelihood of MetS among Chinese children and adolescents aged 7–17 years. Reducing sedentary behavior and screen time may contribute to the prevention of metabolic diseases.

Diabetes and long duration leading to speech-, low/mid-, and high- frequency hearing loss: current evidence from the China National Health Survey 2023.

To examine the effect of diabetes, duration of diabetes, and blood glucose on speech-, low/mid-, and high-frequency hearing loss. In this cross-sectional study, 2821 participants aged 20-87years in the China National Health Survey were included.Diabetes was defined as valid fasting blood glucose (FBG) of ≥ 7.0mmol/L, a self-reported history of diabetes or the use of anti-diabetic medications. Speech-(500, 1000, 2000, and 4000Hz), low/mid- (500, 1000 and 2000Hz), and high-frequency (4000, 6000, and 8000Hz) hearing loss was defined as pure tone average of responding frequencies > 20dB HL in the better ear, respectively. In fully adjusted models, for speech-, low/mid-, and high-frequency hearing loss, compared with no diabetes, those with diabetes (OR[95%CI]: 1.44 [1.12, 1.86], 1.23 [0.94, 1.61], and 1.75 [1.28, 2.41], respectively) and with diabetes for > 5years duration (OR[95%CI]: 1.63 [1.09, 2.42], and 1.63 [1.12, 2.36], 2.15 [1.25, 3.70], respectively) were at higher risk. High FBG level was associated with a higher risk of speech-, low/ mid-, and high-frequency hearing loss. And there were stronger associations between HL and diabetes, longer duration and higher in "healthier population" (no hypertension, no dyslipidemia and younger age). Diabetes, longer duration, and higher FBG level were independently associated with hearing loss for speech-, low/mid- and high-frequency hearing loss, particularly in higher frequency and "healthier population". Paying more attention to hearing loss in those populations could lower the burden of hearing loss.

Prevalence and influencing factors on food allergy among children aged 0-5 years in China

Objective: To describe the prevalence of food allergy among children aged 0-5 years in China and to explore related influencing factors. Methods: Multistage stratified random sampling method was used to collect data from 275 surveillance sites of the China National Nutrition and Health Survey of Chinese children and lactating mothers programs in 31 provinces (autonomous regions and municipalities) of China in 2016-2017. A total of 70 107 participants aged 0-5 years were included in this study. The study collected information of participants' demographic characteristics and food allergies by face-to-face questionnaire. The prevalence of food allergy was analyzed, using the complex data weighting method. The logistic regression models were used to analyze the influencing factors related to food allergy. Results: The overall prevalence of self-reported food allergy among children aged 0-5 years was 4.81%. Prevalence rates in infants aged 0-5 months, and 6-23 months and preschool children aged 2-5 years were 0.81%, 4.68% and 5.26%, respectively. The results of logistic analysis showed that there was a significantly positive correlation between factors including children from 6 months to 5 years old, urban area, southwest area, first-born, mothers with college education or above, and the prevalence of food allergy in children. Shrimp, poultry eggs, crab shellfish, fruit, milk and fish appeared the common allergic foods in children aged 0-5 years, with prevalence rates of self-reported food allergy as 1.55%, 1.25%, 0.99%, 0.97%, 0.87% and 0.86%, respectively. The proportion of single food allergy in children with allergies was 69.85%. Conclusions: Among children aged 0-5 years, the prevalence of self-reported food allergy increases with age, in China. Foods that is prone to allergies include fish, shrimp, crab, shellfish, poultry eggs, milk and fruits, etc. Most allergies were only caused by single food in children, under observation.

The work relative value estimation assessment in China: an empirical research for common surgical procedures.

China's National Health Service Items Standard (NHSIS) establishes a relative value system and plays an important role in pricing. However, there are few empirical evaluations of the objectivity of the NHSIS-estimated relative value. This paper presents a comparison between physician work relative value units (wRVUs) estimates for 70 common surgical procedures from NHSIS and those from the U.S. Medicare Physician Fee Schedule (MPFS). We defined the ratio of the wRVUs for sample procedures to the benchmark procedure (inguinal hernia repair) as a standardized relative value unit (SRVU), which was used to standardize the data for both schedules. We examined the variances in the ranking and quantification of SRVUs across specialties and procedures, as well as how SRVUs impact procedure reimbursement prices between the two schedules. There was no systematic difference between MHSIS-estimated SRVUs and MPFS-estimated, but the dispersion of MPFS-estimated SRVU was greater than that of MHSIS-estimated, and the discrepancies increased with surgical risk and technical complexity. The discrepancies of SRVUs were significant in cardiothoracic procedures. Additionally, whether SRVUs were based on MPFS or MHSIS, there was a positive association between them and payment prices. However, in terms of the impact of SRVUs on payment pricing, the NHSIS system was lower than the MPFS system. China has made incremental progress in estimating the relative value of healthcare services, but there are shortcomings in valuation methods and their impact on pricing. The modular assessment method should be considered as a component to optimize reform.

Does supplemental private health insurance impact health care utilization and seeking behavior of residents covered by social health insurance? Evidence from China National Health Services Survey

BackgroundSupplemental private health insurance (PHI) plays a crucial role in complementing China’s social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system.MethodsData from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences.ResultsAmong UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities.ConclusionThe findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.

Association between physical activity and health-related quality of life among adults in China: the moderating role of age.

The aim of the study was to examine the association between physical activity (PA) and health-related quality of life (HRQOL) among adults and explore the role of age in the association between PA and HRQOL in Shandong, China. We investigated the relationship between PA and HRQOL and examined the moderated role of age in this association among adults with different age groups and physical activity levels. Data were obtained from the sixth China National Health Services Survey conducted in Shandong province in 2018. The multi-stage-stratified cluster random sampling method was used to selected respondents, with individuals aged 18 and above included in the present study. The tool of assessing HRQOL was the three-level EuroQol Five Dimensions Questionnaire (EQ-5D-3L). The study found PA was significantly related to HRQOL (P < 0.05). The interaction analysis indicated that the relationship between PA and HRQOL was significantly different across young, middle-aged, and older adults (P < 0.05). Older adults with the sufficient PA (coefficient = 0.090, 95%CI: [0.081, 0.100]) and active PA (coefficient = 0.057, 95%CI: [0.043, 0.072]) had significantly higher HRQOL compared with young and middle-aged groups. PA was positively associated with HRQOL among the adults. Age played a moderate role between the association between PA and HRQOL. Guidelines for PA should be specifically tailored to adults of different age groups in order to enhance their HRQoL.

The Relationship between Birth Weight and the Risk of Overweight and Obesity among Chinese Children and Adolescents Aged 7-17 Years.

Obesity is a major public health issue in children and adolescents. Our study aimed to examine the impacts of birth weight on overweight and obesity among Chinese children and adolescents. Using data from the China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016-2017, we included 10,041 participants aged 7-17 years. According to birth weight, participants were categorized into six groups, and the birth weight category of 3000 to 3499 g was chosen as the reference group, containing the largest number of children. Logistic regression analyses were used to investigate the association of birth weight with the risk of being obese at 7 to 17 years of age in multivariable-adjusted models. A restricted cubic spline was utilized to show the odds ratios (ORs) of obesity at different birth weight levels. The adjusted ORs for overweight were 0.98 (95%CI 0.63, 1.53), 1.02 (95%CI 0.84, 1.25), 1.34 (95%CI 1.16, 1.55), 1.72 (95%CI 1.35, 2.18), and 1.17 (95%CI 0.71, 1.96) in several birth weight groups, compared with group C (3000-3499 g). The adjusted ORs for obesity were 0.82 (95%CI 0.48, 1.40), 0.77 (95%CI 0.60, 0.98), 1.33 (95%CI 1.13, 1.57), 1.97 (95%CI 1.53, 2.53), and 2.01 (95%CI 1.27, 3.19). Furthermore, children in the post-pubertal stage had a slightly higher risk of overweight and obesity than those in the pre-pubertal and pubertal stage. Moreover, these associations were stronger among boys. The lower part of normal birth weight range is associated with a lower risk of overweight and obesity in children and adolescents. However, higher levels of birth weight increase risk.

Assessing the price levels of medical service and influential factors: evidence from China

BackgroundMedical service prices play a crucial role in cost containment in China. This study aimed to assess the change in medical service price levels at the macro level and the relationship with relevant macroeconomic factors.MethodsData from the 2022 China Statistics Yearbook, the 2022 China Health Statistics Yearbook, and the 2020 China National Health Accounts Report were used. Time trends of health price levels, utilization, and health expenditure were examined. A time-series regression model was employed to measure the impact of service utilization and medical service prices on total medical service expenditure growth from 2000 to 2021. The Johansen cointegration test was conducted to test the cointegrating relationship between medical service price levels and total medical service expenditure, average wage of employees and CPI. The Granger causality test was performed to observe the direction of causality.ResultsDescriptive analyses showed consistent growth in utilization and medical service price levels from 2000 to 2021. The time-series model indicated that medical service expenditure was influenced by the rise in inpatient admissions and price levels of medical service and medicine. The Johansen cointegration test identified a long-term equilibrium relationship between medical service price levels and total medical service expenditure, average wage and CPI. The change in medical service price levels was the Granger cause of the change in medical service expenditure, but it had no impact on average wage and CPI. However, the change in medical service price levels was influenced by these three macroeconomic factors.ConclusionsThe growth of medical service expenditure in China was driven by inpatient use and price level. There was a long-term equilibrium relationship between medical service price levels and relevant macroeconomic factors. However, medical service price levels only affected medical service expenditure and have no impact on average wage and CPI. It is necessary to improve the value transmission mechanism of medical service prices.

A comparative analysis of vaccine lists, prices, and candidates, and the national immunization program between China and the United States

Vaccines have an essential role in preventing infectious diseases and reducing the burden of disease. The differences in vaccine lists and prices, and the National Immunization Program (NIP) and vaccine development between China and the United States (US) in conjunction with epidemiologic data on infectious diseases were systematically compared. The epidemiologic data of infectious diseases in 2019 were extracted from the China National Health Commission and the US Centers for Disease Control and Prevention (CDC). The vaccine list was identified from the China National Medical Products Administration and US Food and Drug Administration databases. Vaccine prices were obtained via the China government procurement platform and the US CDC. The NIP vaccines for China and the US were obtained from the China and US CDCs. Vaccine candidates investigated in 2015-2022 were identified from the China Clinical Trial Registry Platform and the US clinicaltrials.gov database. Differences in the incidence of infectious diseases between China and the US were detected with both countries facing a lack of available vaccines for prevention of many diseases. The number of listed vaccines and preventable diseases in China was 59 and 36, respectively, which was higher than the US (45 and 31, respectively). The median price of NIP vaccines in China was significantly lower than the price in the US (median: $3.8 vs. $20; P&lt;0.001); however, there was no significant difference in the price of non-NIP vaccines (median: $68 vs. $86; P=0.498). Vaccines developed by local manufacturers were less expensive than imported products despite the absence of significant differences (median: $16 vs. $31; P=0.180). The number and types of NIP vaccines used to prevent infectious diseases in China were lower than the US. The majority of vaccine candidates in China were not novel compared to the US. Vaccines marketed in China for infectious diseases were comparable to the US. Our findings suggest that China should further expand NIP vaccines and incentive research and development on novel vaccines to improve accessibility based on infectious disease epidemiology.

Cardio-Oncologic Knowledge of Nurses in the Oncology Service: A Multi-Center Survey in China.

Elucidation of the cardio-oncologic knowledge among the oncology nurses of tertiary hospitals in Shanxi Province to provide better insights and directions for management by nursing managers. China's National Health and Wellness Commission issued the Action Plan for Further Improving Nursing Services in June 2023, which requires nurses to provide patients with physical and mental holistic nursing services, such as medical care, condition observation, assistance with treatment, and health guidance. Most oncology patients are treated with chemotherapy, but the modality can cause greater harm to patients, especially cardiotoxicity. How to provide precise care for chemotherapy patients is a problem for nursing managers. In order to investigate the level of cardio-oncologic knowledge among the oncology nurses of tertiary care hospitals in Shanxi Province, China, a questionnaire was created based on the relevant literature and the provided instructions on cardio-oncology. The chi-squared test was performed for multiple comparisons of the level of knowledge of disease observation, health guidance, and implementation of treatment. Spearman correlation analysis was performed to analyze the correlation between the levels of cardio-oncologic knowledge and general information of hospitals and nurses. Cardio-oncology awareness among the oncology nurses was 0.1%-44.7%, the awareness rate of single dimension was 0 to 3.9%, and overall awareness rate was 0. A partially significant difference was revealed in the two-by-two comparisons of the awareness rates of the three dimensions of disease observation, health guidance, and implementation of treatment (P < 0.05). A correlation was observed between the cardio-oncologic knowledge and some of the hospital and the nurses' general information data (P < 0.05). Oncology nurses exhibited a low rate of awareness related to cardio-oncology. Hospitals could establish oncology nursing teams to train the oncology nurses to promote their cardio-oncologic knowledge and ensure the quality of daily care provided by these nurses.

PP132 Health Technology Assessment Agencies’ Expectations Regarding Patient Experience Data in Australia, China, And Japan

IntroductionHealth technology assessment (HTA) agencies are increasingly embracing patient experience data (PED) to support reimbursement decisions. This study aimed to review HTA agencies’ expectations with regards to utilizing PED to support drug reimbursement in Australia, Japan, and China.MethodsPublished HTA guidance documents were reviewed in 2021 to identify any PED-specific information. If available, recommendations related to the type of PED (e.g., generic vs. disease-specific clinical outcomes assessment (COA)); COA validation, analyses, endpoints and interpretation; and the interest in PED beyond COA in HTA decision-making (e.g., patient preference information) were reviewed. Literature review and semi-structured interviews with key opinion leaders (KOLs) were conducted to further explore these themes and future trends with regards to PED.ResultsAustralia’s Pharmaceutical Benefits Advisory Committee guidance document includes a dedicated section on patient-reported outcomes (PRO), providing details on preferred PRO instruments; validation expectations; and recommended methods to explore score interpretation, assess and report PRO results and handle missing data. While PED derived from non-PRO sources are not discussed in the guidance, the KOL noted that they should not be ruled out. Japan’s Center for Outcomes Research and Economic Evaluation for Health guideline includes a section dedicated to PROs without details related to instrument validation, analyses and interpretation, however, is focused on the use of PRO to inform health economic assessments. In China, the HTA center of China National Health Commission drafted two disease-specific technical guidance documents recommending the inclusion of PROs in efficacy assessments and use of instruments relevant in the Chinese population; these points were echoed by the KOL interviewed.ConclusionsThere are recommendations on PED use included in country-specific guidance documents, however their level of detail varies greatly. Knowing each agency’s expectations with regards to PED is key when submitting HTA evidence dossiers and should be considered early in clinical trial design to integrate market access perspectives and optimize drug development.

Novel herbal beverage ameliorates exercise-induced fatigue in mice by modulating oxidative stress and reshaping the gut microbiota

With the demands of enhancing exercise performance, dietary supplements are widely used in the health management of athletes and who engaged in strenuous exercise. Based on the list of edible and medicinal materials approved by China's National Health Commission, we composed an herbal beverage formula named SRB, initially identified its chemical composition, and clarified its preventive effect on exercise-induced fatigue (EIF). SRB supplementation for four weeks significantly enhanced exercise performance in mice, as reflected by exhaustive swimming test and treadmill exercise test. In mice that underwent one single exhaustive exercise, SRB supplementation markedly reduced metabolite accumulation, increased glycogen contents in the liver and muscle, promoted anti-oxidative enzyme activities, decreased hepatic malondialdehyde (MDA) level, and protected quadriceps femoris morphology, respectively. Anti-oxidative stress effect of SRB may be relevant with increased gene expressions of nuclear factor-erythroid 2-related factor 2 (Nrf2) and antioxidant response element (ARE)-dependent gene. Moreover, SRB treatment altered gut bacterial community structure, e.g., increased the relative abundance of short-chain fatty acids (SCFAs)-producing bacteria and decreased the relative abundance of sulfate-reducing bacteria. Altogether, we identified SRB as an effective anti-EIF dietary supplement with prebiotic effects in C57BL/6 mice.

Does affordable housing alleviate migrant workers' overwork in Chinese cities?

Prior research on overwork has predominantly been conducted in developed countries. This study examines the role of affordable housing in Chinese cities and provides evidence from a developing country. Using data from China's National Health and Family Planning Commission's “China Migrants' Dynamic Survey,” this study explores the relationship between affordable housing and overwork among migrant workers in Chinese cities, as well as the mechanism underlying this association. The results imply that migrant workers in China can work fewer hours if they reside in affordable housing. The impact of affordable housing on the overwork of migrant workers is partially mediated by their housing cost burden and their sense of local self-identity. Women, the younger generation, and later-arriving migrant workers are more negatively affected than men, the older generation, and earlier-arriving migrants. This study gives insight into the evaluation of the efficiency of affordable housing in China and evidence for future research on the issue of overwork in developing nations.

Evaluating the long-term cost-effectiveness of fixed-ratio combination insulin degludec/liraglutide (IDegLira) versus other treatment regimens in the chinese type 2 diabetes patients

Background and aimsTo assess the cost-effectiveness of utilizing IDegLira in comparison to other treatment regimens ( liraglutide and degludec) in managing type 2 diabetes, taking into account the Chinese healthcare system’s perspective.MethodsThe clinical data were obtained from the randomized controlled trials (RCTs) of the DUAL I and DUAL II evidence studies that took place in China. To estimate the lifetime quality-adjusted life-years (QALYs) and direct medical costs of patients receiving different treatment strategies from a long-term perspective, the IQVIA CORE Diabetes Model version 9.0 (IQVIA, Basel, Switzerland) was utilized. The costs were evaluated from the perspective of the China National Health System. Future costs and clinical benefits were discounted annually at 5%, and sensitivity analyses were conducted.ResultsIDegLira was projected to reduce the incidence of diabetes-related complications and improve quality-adjusted life expectancy (QALE) versus liraglutide and degludec. A survival benefit was observed with IDegLira over Liraglutide (0.073 years). Lifetime costs were lower by Chinese yuan (CNY) 27,945 on IDegLira than on Liraglutide therapy. A similar survival benefit was observed with IDegLira over degludec (0.068 years). Lifetime costs were lower by CNY 1196 on IDegLira than on degludec therapy. Therefore, IDegLira was found to be cost-effective versus liraglutide and degludec with incremental cost-effectiveness ratios of Dominant per QALY gained, respectively, under the threshold of three times the gross domestic product (GDP) per capita in China.ConclusionIDegLira is a cost-effective hypoglycemic treatment option that delivers positive clinical outcomes while also reducing costs for Chinese patients living with type 2 diabetes.

Analysis of Herbal Medicine in the Clinical Guidelines of Korea and China for COVID-19

COVID-19 is an acute infectious disease caused by SARS-CoV-2 that has infected more than 700 million people around the world and left many deaths. In Korea and China, Korean medicine and Traditional Chinese Medicine were used to treat COVID-19, and the key element between them was herbal medicine. Clinical guidelines for herbal medicine have been published in Korea and China. In this review, the Korean and Chinese guidelines were compared and analyzed. This review was based on the latest revised clinical guidelines. The Korean guidelines covered all three guidelines published by The Association of Korean Medicine and The KM Professor Council of Internal Medicine of the Respiratory System. The Chinese guideline was published by the China National Health Commission. Based on research trends, a comprehensive comparison was made of the suggested prescriptions for each severity of COVID-19. It is expected that this review will be used as a reference for the treatment of COVID-19 or new infectious diseases in the future.