Regions Of China Research Articles

Ambient air pollution contributed to pulmonary tuberculosis in China

ABSTRACT Published studies on outdoor air pollution and tuberculosis risk have shown heterogeneous results. Discrepancies in prior studies may be partially explained by the limited geographic scope, diverse exposure times, and heterogeneous statistical methods. Thus, we conducted a multi-province, multi-city time-series study to comprehensively investigate this issue. We selected 67 districts or counties from all geographic regions of China as study sites. We extracted data on newly diagnosed pulmonary tuberculosis (PTB) cases, outdoor air pollutant concentrations, and meteorological factors in 67 sites from January 1, 2014 to December 31, 2019. We utilized a generalized additive model to evaluate the relationship between ambient air pollutants and PTB risk. Between 2014 and 2019, there were 172 160 newly diagnosed PTB cases reported in 67 sites. With every 10-μg/m3 increase in SO2, NO2, PM10, PM2.5, and 1-mg/m3 in CO, the PTB risk increased by 1.97% [lag 0 week, 95% confidence interval (CI): 1.26, 2.68], 1.30% (lag 0 week, 95% CI: 0.43, 2.19), 0.55% (lag 8 weeks, 95% CI: 0.24, 0.85), 0.59% (lag 10 weeks, 95% CI: 0.16, 1.03), and 5.80% (lag 15 weeks, 95% CI: 2.96, 8.72), respectively. Our results indicated that ambient air pollutants were positively correlated with PTB risk, suggesting that decreasing outdoor air pollutant concentrations may help to reduce the burden of tuberculosis in countries with a high burden of tuberculosis and air pollution.

Dynamic Trends in Maize Diseases and Pests Across Six Regions in China Over Two Decades

Dynamic Trends in Maize Diseases and Pests Across Six Regions in China Over Two Decades

Ancient wisdom: A new perspective on the past and future Chinese precipitation patterns based on the twenty-four solar terms

Precipitation, as a crucial component of the hydrological cycle, exhibits intense responsiveness to climatic changes. Accurately and finely describing precipitation patterns on a temporal scale within complex climatic regions is a matter that has consistently garnered attention. China, with its intricate geographical environment spanning five climatic zones, has seen its laboring populace develop the unique Twenty-Four Solar Terms (TFST) calendar from ancient times to macroscopically describe climatic shifts and to guide their agricultural activities. Here, based on the chronological framework of the TFST, we revisited and validated the response of typical solar terms to conventional precipitation indicators over the past 40 years in China. By comparing the accumulated precipitation volume and the number of effective precipitation days 30 days before and after the typical solar terms, we established the statistical credibility of this ancient calendar system’s summarization of precipitation patterns. Furthermore, the study examines the response of various future extreme precipitation events to the TFST and their spatial distribution patterns. We identified that more than 70 % of regions in China experienced a concentration of extreme precipitation events during the XiaoShu and DaShu solar terms. Under four different future scenario models, there is prediction that over 55.2 % of the areas in China will also have extreme precipitation events predominantly during the same two solar terms. Additionally, in the Qinghai-Tibet region, there is a trend indicating an increased risk of extreme precipitation frequency during these two critical solar terms associated with rising carbon emissions, with a significance level averaging over 95 %. This research deeply integrates modern meteorological and hydrological science with traditional culture, allowing for a nuanced understanding of the periodicity of extreme precipitation. It also offers a novel perspective and theoretical basis to guide flood prevention efforts and studies on the regularities of extreme precipitation.

Examining relations between sea-level anomalies in the Niño 3.4 region and terrestrial hydroclimatic conditions in China

Examining relations between sea-level anomalies in the Niño 3.4 region and terrestrial hydroclimatic conditions in China

Spatiotemporal variations and priority ranking of emerging contaminants in Nanwan Reservoir: a case study from the agricultural region in Huaihe River basin in China

The presence of emerging contaminants (ECs) in drinking water sources is an increasing concern, yet limited data exists on their occurrence and risk in the upper Huaihe River Basin, an important agricultural region in Central China. This study investigated 70 ECs, including pesticide and antibiotics in surface water from drinking water source areas in Nanwan Reservoir along the upper reaches of the Huaihe River Basin to prioritize the ECs based on ecological risk and health risk assessment. A total of 66 ECs were detected in the surface water at least once at the selected 38 sampling sites, with concentrations ranging from 0.04-2508 ng/L. Ecological risk assessment using the risk quotient (RQ) method revealed high risks (RQ > 1) from 7 ECs in the dry season and 15 ECs in the wet season, with triazine pesticides as the main contributors. Non-carcinogenic risks were below negligible levels, but carcinogenic risks from neonicotinoid and carbamate pesticides and macrolide antibiotics were concerning for teenagers. Ciprofloxacin exhibited a high level of resistance risk during the wet season. A multi-indicator prioritization approach integrating occurrence, risk, and chemical property data ranked 6 pesticides and 3 antibiotics as priority pollutants. The results highlight EC contamination of drinking water sources in this agriculturally-intensive region and the need for targeted monitoring and management to protect water quality.

Static-dynamic characteristics and management scheme of county space resilience based on geographical natures—An empirical study of 95 counties from Jiangsu Province, China

Resilient counties has the capability to navigate adverse environmental changes, adaptively reallocate resources during challenges, and bolster county competitiveness. This study introduces an original framework for nurturing resilient counties based on geographical natures, emphasizing the role of geographic space evolution, termed county space resilience (CSR). This study focuses on 95 counties in Jiangsu, a prominent province in the rapidly urbanizing region of eastern China, as a case study. Employing a multi-dimensional feature model and LISA spatiotemporal transition analysis, this study analyzes the static-dynamic characteristics of CSR and proposes a regional guidance scheme. This study draws three key conclusions. Firstly, it reveals that the average CSR value decreased from 0.327 in 2000 to 0.320 in 2005, then increased to 0.380 in 2021, and the geographic trend of transitioning from more economically developed zones to less developed ones. Secondly, the general structural characteristics of CSR are classified into four groups: upgrade transformation, focus optimization, potential enhancement, and safety adjustment. Furthermore, the spatial–temporal coalescence of the Moran’s I scatterplot equals 0.684, signifying stability in the spatial correlation of CSR. Additionally, the dynamic evolution characteristics of CSR are categorized into positive and negative types, with the Yangtze River Green Development Belt acting as the boundary. Lastly, this study constructs a management scheme comprising zoning control and classification strategy tailored for different counties, offering strategic recommendations customized for each. This scheme can serve as a decision-making foundation for policymakers in county development endeavors, fostering the cultivation of resilient counties.

Identification and dynamic evolution of land use conflict potentials in China, 2000–2020

Under the background of rapid urbanization, a series of urgent problems have emerged in China, such as tightening resource constraints and intensifying land use conflicts (LUCs). Based on the perspective of agricultural production – residents’ life – ecological security, this study took China as the study area, applied the multi-criteria evaluation analysis method to diagnose the LUC type based on spatial statistics, coupling relationship matrix, comprehensive conflict index, and spatial autocorrelation model, then divided the LUC risk changes into seven patterns, and analyzed their spatial evolution characteristics. The results demonstrated that the scale of competition for scarce land between agriculture, construction, and ecology increased by 3.4 % over the last 20-year period. High conflict zone was mainly located in the eastern plains, which was also the main distribution zone of agriculture-construction conflict, while the agriculture-ecology conflict zone was mainly located in the west. Over time, LUC risk grade changed in 14.3 % of the study area, with the largest area of transitions from no conflict to moderate conflict (34.78 %). High intensification zone coincided almost entirely with ecologically fragile regions of the Midwest, underscoring the critical importance of LUC perspectives in ecological conservation. We provided a new perspective for the study of LUC changes and a scientific reference for realizing sustainable land use management in China and other regions.

Heat storage and release performance of solar greenhouses made of composite phase change material comprising methyl palmitate and hexadecanol in cold climate

Solar greenhouses play a crucial role in winter crop cultivation in the cold regions of China; however, adverse weather conditions such as low temperatures can negatively affect their production. Therefore, improving the greenhouse thermal environment and energy utilisation is crucial for optimising greenhouse productivity. One effective method of storing energy is phase transition. In this study, melt blending was used to prepare composite phase change materials (CPCMs), with methyl palmitate and hexadecanol as raw materials. In addition, ceramsite was encapsulated with a styrene-acrylic emulsion to form a shape composite phase change material (SCPCM). The results showed that the latent heat of phase change of the CPCMs was 221 J/g, with an initial phase change temperature of 23.48 ℃. The encapsulation of the SCPCM with a styrene-acrylic emulsion significantly reduced leakage. Phase-change ceramsite concrete slabs were developed by integrating the SCPCM into concrete. These slabs were used to construct large-phase-change and non-phase-change greenhouses. A temperature-testing system was installed in the greenhouses to examine the temperature variations and distributions under typical sunny and cloudy conditions. Results revealed that compared with the control greenhouse, the phase-change greenhouse exhibited a decrease of 3.0 ℃ in the maximum indoor temperature during sunny days and an increase of 3.2 ℃ in the minimum indoor temperature at night. This study highlights the effective temperature control capabilities of phase-change ceramsite concrete slabs for improving energy utilisation and provides valuable theoretical and technical insights for the future utilisation and widespread adoption of phase-change greenhouses.

Grass (Poa annua L.) cover for eight years as an effective strategy for recovering soil moisture

Deep soil desiccation has become a major obstacle to restoring vegetation in the Loess Plateau region of China. The restoration of deep soil water plays an important role in ecosystem health. In the present study, we compared the effects on moisture variations in deep dry soil of grass cover and clean tillage treatments based on in-situ soil column monitoring for eight years. The results showed that the dry soil layers could temporarily disappear and reappear again with rainfall under clean tillage. However, grass cover effectively increased the deep soil moisture. Grass primarily consumed soil moisture from the shallow layer (0–2 m), and the total amount of water consumed during the whole growth period was less than the annual rainfall in dry years. The average soil desiccation index decreased by 24.20 % and the deep soil water moisture (2–10 m) recovered from 7.5 % to 12.8 % after eight years, with an annual average recovery of 0.66 %. Thus, it would take half a year to recover to the stable field capacity and 14 years to reach the field capacity. Recovery of the soil moisture also depended on the rainfall supply. We found that precipitation had an obvious lagged effect of approximately two years on the supply of deep soil moisture. Our findings contribute to understanding how to alleviate dry soil layer, with potentially helpful implications for the ecological health in arid and semiarid regions.

Diagnosis and treatment of anterior cruciate ligament injuries: Consensus of Chinese experts part II: Graft selection and clinical outcome evaluation

BackgroundIn the recent decade, there has been substantial progress in the technologies and philosophies associated with diagnosing and treating anterior cruciate ligament (ACL) injuries in China. The therapeutic efficacy of ACL reconstruction in re-establishing the stability of the knee joint has garnered widespread acknowledgment. However, the path toward standardizing diagnostic and treatment protocols remains to be further developed and refined. ObjectiveIn this context, the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM) collaboratively developed an expert consensus on diagnosing and treating ACL injury, aiming to enhance medical quality through refining professional standards. MethodsThe consensus drafting team invited experts across the Greater China region, including the mainland, Hong Kong, Macau, and Taiwan, to formulate and review the consensus using a modified Delphi method as a standardization approach. As members of the CSSM Lower Limb Study Group and the CAOS Arthroscopy and Sports Medicine Study Group, invited experts concentrated on two pivotal issues: “Graft Selection” and “Clinical Outcome Evaluation” during the second part of the consensus development. ResultsThis focused discussion ultimately led to a strong consensus on nine specific consensus terms. ConclusionThe consensus clearly states that ACL reconstruction has no definitive “gold standard” graft choice. Autografts have advantages in healing capability but are limited in availability and have potential donor site morbidities; allografts reduce surgical trauma but incur additional costs, and there are concerns about slow healing, quality control issues, and a higher failure rate in young athletes; synthetic ligaments allow for early rehabilitation and fast return to sport, but the surgery is technically demanding and incurs additional costs. When choosing a graft, one should comprehensively consider the graft's characteristics, the doctor's technical ability, and the patient's needs. When evaluating clinical outcomes, it is essential to ensure an adequate sample size and follow-up rate, and the research should include patient subjective scoring, joint function and stability, complications, surgical failure, and the return to sport results. Medium and long-term follow-ups should not overlook the assessment of knee osteoarthritis.

Development of Reliable Male-Specific Molecular Markers for Genetic Sex Identification in Sea Cucumber Apostichopus japonicus.

Apostichopus japonicus is an important marine aquaculture species in China, with high nutritional and economic value. In A. japonicus, there is no obvious sexual dimorphism in external appearance, and sex differentiation primarily relies on the observation of mature gonads after dissection, which leads to difficulties in sex identification. The confusion in sex identification greatly reduces breeding efficiency in the sea cucumber industry. Therefore, developing a reliable sex-specific marker is crucial. In this study, we identified 586 male-specific sequences through whole-genome assembly and sequence alignment, but did not identify any female-specific sequences, inferring an XY-type sex determination system in sea cucumbers. We developed a set of male-specific molecular markers to establish an accurate, stable, and widely adaptable genetic sex identification technique for A. japonicus. The male-specific molecular markers were validated with 100% accuracy in sea cucumber populations from six different geographical regions in China. In conclusion, this study provides further evidence for the XY-type sex determination system in A. japonicus and establishes an effective genetic sex identification method for multi-geographic populations, which benefits future study on reproductive biology and has significant implications in sea cucumber aquaculture industry.

Risk assessment of karst water inrush in tunnel engineering based on improved game theory and uncertainty measure theory.

The sudden inrush of water poses a serious threat to the safety of workers during tunnel construction in the karst region of southwest China. To mitigate this risk, a model is proposed to assess the risk of water surge through a tunnel by combining improved game theory with uncertainty measure theory. Eight indicators of risk were extracted based on the solubility of rock, its geological structure, capacity for surface catchment, and hydrogeological factors, and were incorporated into the proposed model. The subjective weights of these indicators were obtained using the analytic hierarchy process, while their objective weights were calculated through the entropy weighting method and the criteria importance through intercriteria correlation method. An improved game theory-based method of combinatorial weighting was then used to construct the corresponding weight vectors. Single-indicator measurement functions and multi-indicator measurement matrices were utilized to classify and evaluate the indicators of the risk of a surge in water level based on a confidence criterion. The proposed method was applied to five typical karst sections of the Yanjin Tunnel of the Chongqing-Kunming High-speed Railway Project, and the method was validated by comparing the recorded and estimated inflow volume ranges during the project's construction, showing consistency with the actual evaluation results. This proposed model thus offers a practical tool for assessing the risk of water inrush in karst tunnels.

Enhanced Freeze‐Thaw Cycle Altered the Simulations of Groundwater Dynamics in a Heavily Irrigated Basin in the Temperate Region of China

Enhanced Freeze‐Thaw Cycle Altered the Simulations of Groundwater Dynamics in a Heavily Irrigated Basin in the Temperate Region of China

Spatial analysis of the impact of urban built environment on cardiovascular diseases: a case study in Xixiangtang, China.

The built environment, as a critical factor influencing residents' cardiovascular health, has a significant potential impact on the incidence of cardiovascular diseases (CVDs). Taking Xixiangtang District in Nanning City, Guangxi Zhuang Autonomous Region of China as a case study, we utilized the geographic location information of CVD patients, detailed road network data, and urban points of interest (POI) data. Kernel density estimation (KDE) and spatial autocorrelation analysis were specifically employed to identify the spatial distribution patterns, spatial clustering, and spatial correlations of built environment elements and diseases. The GeoDetector method (GDM) was used to assess the impact of environmental factors on diseases, and geographically weighted regression (GWR) analysis was adopted to reveal the spatial heterogeneity effect of environmental factors on CVD risk. The results indicate that the built environment elements and CVDs samples exhibit significant clustering characteristics in their spatial distribution, with a positive correlation between the distribution density of environmental elements and the incidence of CVDs (Moran's I > 0, p < 0.01). Further factor detection revealed that the distribution of healthcare facilities had the most significant impact on CVDs (q = 0.532, p < 0.01), followed by shopping and consumption (q = 0.493, p < 0.01), dining (q = 0.433, p < 0.01), and transportation facilities (q = 0.423, p < 0.01), while the impact of parks and squares (q = 0.174, p < 0.01) and road networks (q = 0.159, p < 0.01) was relatively smaller. Additionally, the interaction between different built environment elements exhibited a bi-factor enhancement effect on CVDs. In the local analysis, the spatial heterogeneity of different built environment elements on CVDs further revealed the regional differences and complexities. The spatial distribution of built environment elements is significantly correlated with CVDs to varying degrees and impacts differently across regions, underscoring the importance of the built environment on cardiovascular health. When planning and improving urban environments, elements and areas that have a more significant impact on CVDs should be given priority consideration.

Poly-γ-glutamic acid enhanced the yield and photosynthesis of soybeans by adjusting soil aggregates and water distribution.

Poly-γ-glutamic acid (γ-PGA) is employed extensively in agriculture to enhance soil water retention; however, the underlying mechanism by which γ-PGA improves soil structure and soybean productivity in arid regions remains poorly understood. A micro-scale field experiment was conducted in the arid region of northwest China, employing five concentrations of γ-PGA to investigate its impacts on soybean yield, photosynthesis, and water-use efficiency, as well as soil aggregates and water distribution. The five levels of γ-PGA were 0 (CK), 10 (P1), 20 (P2), 40 (P3), and 80 kg ha-1 (P4). The results demonstrated that the application of γ-PGA significantly improved soybean yield, photosynthesis, and chlorophyll content. It resulted in a decrease in soil aggregate content with a maximumdiameter of less than 0.053 mm and an increase in the stability of soil aggregates in the uppermost layer of the soil (0-30 cm). The application of γ-PGA significantly increased soil water content, particularly in the uppermost layer of the soil, and effectively reduced water consumption and improving water use efficiency in soybeans. Overall, the P3 treatment exhibited the most pronounced improvement of soybean yield, photosynthesis, water-use efficiency, as well as distribution of soil aggregates and water. The correlation matrix heatmap also revealed a strong correlation between improvement of soybean yield or photosynthesis at various γ-PGA application levels and the enhancement of soil stability or soil water content. The multivariate regression analysis revealed that an optimal application level of 46 kg ha-1 γ-PGA could enhance effectively both yield and water use efficiency of soybean in the arid region of northwest China. © 2024 Society of Chemical Industry.

Prevalence and Risk Factors of Chronic Kidney Disease in Patients With Type 2 Diabetes in China: Cross-Sectional Study.

Chronic kidney disease (CKD) is a significant long-term complication of diabetes and is a primary contributor to end-stage kidney disease. This study aimed to report comprehensive nationwide data on the prevalence, screening, and awareness rates of CKD in Chinese patients with type 2 diabetes, along with associated risk factors. Baseline data analysis of the ongoing prospective, observational IMPROVE study was conducted. The study cohort comprised patients who had been diagnosed with type 2 diabetes more than 12 months prior, received at least 1 hypoglycemic medication, and were aged ≥18 years. The participants completed questionnaires and underwent laboratory assessments, including blood and urine samples. The data encompassed patient demographics, medical history, concurrent medications, and comorbidities. Comprehensive evaluations involved physical examinations, urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), fasting blood glucose, 2-hour postprandial blood glucose, fasting blood lipid profile, and urinalysis. Descriptive statistics were applied for data interpretation, and logistic regression analyses were used to identify the CKD-associated risk factors in patients with type 2 diabetes. A national study from December 2021 to September 2022 enlisted 9672 participants with type 2 diabetes from 45 hospitals that had endocrinology departments. The enrollees were from diverse regions in China, as follows: central (n=1221), east (n=3269), south (n=1474), north (n=2219), and west (n=1489). The prevalence, screening, and awareness rates of CKD among patients with type 2 diabetes were 31% (2997/9672), 27% (810/2997), and 54.8% (5295/9672), respectively. Multivariate binary regression analysis revealed that the CKD risk factors were screening, awareness, smoking, age, diabetes duration, concurrent antihypertensive and microcirculation medications, diabetic complications (foot, retinopathy, and neuropathy), hypertension, elevated low-density lipoprotein (LDL) cholesterol, and suboptimal glycemic control. Subgroup analysis highlighted an increased CKD prevalence among older individuals, those with prolonged diabetes durations, and residents of fourth-tier cities. Residents of urban areas that had robust educational and economic development exhibited relatively high awareness and screening rates. Notably, 24.2% (1717/7107) of patients with an eGFR ≥90 mL/min/1.73 m2 had proteinuria, whereas 3.4% (234/6909) who had a UACR <30 mg/g presented with an eGFR <60 mL/min/1.73 m2. Compared with patients who were cognizant of CKD, those who were unaware of CKD had increased rates of HbA1c ≥7%, total cholesterol >5.18 μmol/L, LDL cholesterol >3.37 μmol/L, BMI ≥30 kg/m2, and hypertension. In a Chinese population of adults with type 2 diabetes, the CKD prevalence was notable, at 31%, coupled with low screening and awareness rates. Multiple risk factors for CKD have been identified. ClinicalTrials.gov NCT05047471; https://clinicaltrials.gov/study/NCT05047471.

Correction to: Inter- and intraspecific adaptations of pteridophyte leaf traits in limestone and non-limestone forests of monsoon tropical regions of southwest China

Correction to: Inter- and intraspecific adaptations of pteridophyte leaf traits in limestone and non-limestone forests of monsoon tropical regions of southwest China

Exploring impact of green finance and natural resources on eco-efficiency: case of China.

China ranks 160 out of 180 countries in terms of ecological efficiency, with an EPI score of 28.40 and a 10-year average change in score of 11.40. This article examines the impact of green finance and China's natural resources on regional ecological efficiency using the Tobit regression model. The study uses the average yearly exchange rate to normalize dollar-related values and GDP to 2012 RMB using the price deflator. Variables used as explanatory tools include green financing, the availability of natural resources, and regional eco-efficiency. The results of the study imply that natural resources in eastern region of China are better managed as and have avoided the resource curse as compared to central and western regions. Resources temporarily support area economic and social growth. However, resource agglomeration locks many elements in the resource industry and degrades regional industrial development, generating environmental and social difficulties that may hinder regional economic progress. Given that Foreign Direct Investment (FDI) increases regional eco-efficiency after accounting for adjustment. The FDI positively correlated with ecological efficiency in the east zone, while central and western zones have negative correlations. The industrial development of the nation negatively impacts ecological efficiency in the East, Midwest, and West regions. Western results are distinctive, with ecological efficiency and regional economic growth frequently going hand in hand.

The evolution of habitat quality and its response to land use change in the coastal China, 1985-2020.

The coastal region of China is a typical area characterized by a developed economy, yet it faces prominent resource and environmental issues, and it is of great significance to quantitatively assess the ecological effects resulting from rapid urbanization and industrialization. Based on the land use data from 1985 to 2020, and the InVEST modeling and relevant spatial data sources, the paper analyzed the spatial and temporal changes in land use cover and habitat quality in the coastal China over the past 30 years. The results show that: 1) land use cover in the coastal China has changed significantly during the study period, with the area of cultivated land continuing to decrease and construction land expanding; 2) the trend of habitat quality degradation in was obvious, with the area of low-value habitat quality continuing to increase. Spatially, they were mainly located in the three major urban agglomerations undergoing rapid industrialization and urbanization; 3) The average degradation of habitats increased significantly between 1990 and 2000 and 2010-2020. The rate of change in areas with different degradation levels from 1990 to 2000 was higher than in other periods. The low-value areas of habitat degradation are mainly located in hilly and mountainous regions. 4) The transfer of habitat grades was generally characterized by a shift from high grade to low grade. This trend of conversion was due to the large-scale occupation of cultivated land by construction land and the long-term encroachment of ecological land by cultivated land. For future development, it is recommended to improve the land use regulation system based on the principles of sustainable development, with a particular focus on habitat protection. Additionally, efforts should be made to strengthen the development of ecological agriculture, carry out ecological protection and restoration, and improve the mechanisms for coordinating land and sea management.

Regional price differences of medical services: evidence from China.

Price levels of medical services may vary across regions with different income levels, which would raise concerns about the equal access to medical services. This study aimed to estimate the spatial price index of medical services to measure price levels across 31 provincial regions in China. Price data were collected from medical service price schedule in each region. Two methods based on the Purchasing Power Parities were used to estimate the spatial price index and measure price differences across regions. The two-way fixed effects models were used to examine the association between medical service price levels and income levels, and further investigate the impacts of price differences on utilization of medical services and medical expenditure. The consistent estimation results were given by two methods. Medical service price level in the highest-price region was found to be 74% higher than the lowest. There was a significant negative correlation between price levels and income levels, as well as price levels and the utilization of outpatient services. Moreover, we also found a 1% increase in medical service price level was significantly associated with a 0.34% and 0.24% increase in the medical service expense per outpatient visit and per inpatient respectively. Regions in China had significant gaps in medical service price levels. Policymakers should pay more attention to regional price differences and take great measures such as enhancing financial protection to ensure the equal access to medical services and better achieve the universal health coverage.