Cross-sectional Survey Research Articles

The impact of COVID-19 on resident doctors as the frontline in health services

As the number of confirmed cases of COVID-19 increases, the workload due to the pandemic can affect health workers and increase the risk of psychological stress. Psychological factors such as anxiety can cause various physiological responses, including gastroesophageal reflux disease (GERD) symptoms. The persistent symptoms of GERD can reduce the patient's quality of life. A cross-sectional survey was conducted in October 2021 at the Dr. Zainoel Abidin Regional General Hospital, Banda Aceh. A total of 91 Specialist Medical Education Program responded to the study. Data from respondents were collected through the generalized anxiety disorder-7 (GAD-7), GERD-Q, and WHOQOL-BREF questionnaires. The statistical analysis used was the contingency coefficient test. The results showed that 9.9% of respondents experienced suggestive GERD, minimal anxiety (92%), and good quality of life (51.6%). There was a significant relationship between anxiety levels and quality of life and the GERD prevalence of Specialist Doctor Education Program Participants during the COVID-19 pandemic (p<0.05). Most Specialist Medical Education Program participants did not suffer from GERD with minimal anxiety, followed by mild and moderate anxiety. The majority had a good and moderate quality of life during the COVID-19 pandemic.

Exploring the Roles, Functions, and Work Experiences of Nurse Scientists in the Veterans Health Administration.

The aim of this project was to describe nurse scientists' roles, functions, and work experiences in the Veterans Health Administration (VHA). Nurse scientists play a critical role in shaping the culture of clinical inquiry and closing the gap between knowledge and practice. A cross-sectional survey was used to collect information on sociodemographics, workload, research, clinical practice, education, and time/effort. Data were examined using descriptive statistics and χ2 analyses. One hundred forty-four nurse scientists completed the survey. These nurse scientists serve dynamic and critical roles in conducting research, implementing evidence-based practice, and reforming policy. Research effort was limited due to workload and infrastructure constraints. Better research infrastructure was associated with higher research productivity and funding. This survey highlights the needs and challenges nurse scientists experience in conducting research and advancing VHA's mission. Given the national shortage of PhD-prepared nurses, long-term strategies are needed to attract, hire, and retain nurse scientists in healthcare systems.

Usage of temporary anchorage devices: A cross-cultural and cross-sectional survey of orthodontists in Australia and the UK

Detailed insight regarding the use of temporary anchorage devices (TAD) in Australia and the United Kingdom (UK) is lacking. The primary aim of the present cross-sectional survey was to investigate TAD usage among UK-based and Australian-based orthodontists. The secondary objectives were to compare TAD-related preferences and protocols between orthodontists in the two countries. A pilot-tested electronic questionnaire was distributed to members of the British Orthodontic Society and the Australian Society of Orthodontists. Questions pertained to their demographic details, and current use of TADs including protocols, treatment objectives and factors influencing their use. A total of 192 responses were recorded (Australia: 122; UK: 70). One hundred and forty-two respondents (74.0%) reported using TADs as part of their orthodontic treatment, 77.0% in Australia (n=94) and 68.6% in the UK (n=48). Molar protraction was the most common procedure for which TADs were reportedly used (Australia: n=118; 87.2%, UK: n=36; 75.0%). "Loosening" was the most prevalent reported complication overall (n=124; 90.1%). "Confidence", "insufficient postgraduate education" and "availability of equipment" were the factors that most influenced the decision not to provide TADs. Most orthodontists in both countries provided TADs. TAD protocols of orthodontists in both countries were reported. Similarities and differences regarding TAD-related clinical practices and procedures, complications and factors influencing the use of TADs and reasons for not using TADs were explored. Information from the present study can provide baseline data for future related studies in each country and for comparison of TAD usage in other countries.

Knowledge of tuberculosis among physicians working at community health stations in Vietnam

Tuberculosis (TB) remains a significant health problem worldwide, including in Vietnam, where around 174,000 newly diagnosed cases and 13,200 patients died in 2018. There are challenges in the diagnostic process, treatment, and follow-up. The physicians with knowledge of TB working at commune health stations play an essential role in this struggle. The primary purpose of this study was to evaluate knowledge of TB and related factors among physicians working at community health stations in the Northern provinces of Vietnam. A cross-sectional survey was implemented on 335 physicians working at community health stations in 5 Northern provinces in Vietnam from September 2019 to October 2020. The result showed that the TB knowledge of physicians was not good. There were some severe knowledge gaps concerning at-risk groups, the main symptoms of TB, sputum tests for both diagnosis and follow-up and management of attack therapy. The TB training participants had better TB knowledge than others (aOR=1.68; 95%CI: 1.047-2.712). This study underlines the importance of clinical experience and TB training to TB knowledge. We suggest that a TB training plan is required for physicians. Our survey results could inform the process of defining the physicians who work at community health stations' role in TB management in the future.

Prevalence and Correlates of Dry Eye in a German Population Sample.

In this cross-sectional survey, we assessed the prevalence of dry eye disease (DED) in a representative German population sample. In addition, we examined the associations between DED, health-related quality of life (HRQoL), and level of fatigue. Finally, we further validated the German version of the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and present norm data of the German population. A random sample of German residents aged 16 years and older was recruited between October and December 2021. All participants completed the SPEED, Short Form 36, and Multidimensional Fatigue Inventory 20 questionnaires. Of the 2495 participants who completed the survey, 450 (21.6%; 95% confidence intervals 20.0-23.1) reported a SPEED total score of ≥4, indicating a positive screening for DED. DED was significantly more common in women and older age. Participants who screened positive for DED reported significantly higher levels of fatigue and lower values in all domains of HRQoL. A receiver operating characteristic curve of the SPEED was generated using an ophthalmologist's diagnosis. The area under the curve was estimated to be 0.886 (95% confidence intervals 0.858-0.913). A cutoff score ≥4 seemed to be appropriate as an indicator of DED. Cronbach's α was excellent (0.95). DED is common in the German population. We confirmed associations with sex, age, HRQoL, and fatigue level, indicating a high burden of DED. The German version of the SPEED is a valid instrument for the assessment of DED symptoms.

Investigation of digital competence of elementary school teacher in West Nusa Tenggara: A cross-section survey study

As educational facilitators, teachers should have good digital competence to successfully integrate technology into the learning process. This cross-sectional survey research method was conducted on the needs of digital elementary teachers in West Nusa Tenggara. Respondents were 213 primary school teachers from 10 districts in West Nusa Tenggara, Indonesia. The data collection process is conducted online and is anonymous to maintain the privacy of respondents using the Google Form platform. The data analysis used was the Mann-Whitney U test, as we wanted to compare the competencies of male and female teachers. Moreover, the researchers also conducted FGDs with Heads of Education Bureau in 10 districts of NTB to verify the results in this area. The results of this study show that the digital competence primary school teachers either man or woman teachers are still low. In addition, the teacher's skills in using computers, the Internet, and software in the classroom are minimal. The opportunities for teachers to use the Internet are quite high, but teachers do not use it for classroom learning. Teachers believe that technology can help them withhold concepts or knowledge from students. However, teachers also fear the negative effects if children interact with Technology too often.

Development of manufacturing engineering program of Bulacan State University using employability tracer study

<span lang="EN-US">Tracer study is one of the continuous quality improvement tools for curriculum development. The graduates are invited to answer the tracer form to determine their employability. Since the Manufacturing Engineering program in Bulacan State University (BuLSU) is the youngest engineering program, there is minimal data on graduates available, especially on the details of their first jobs, such as the first job related to the program, time taken to land their first job, gross monthly salary, and learning competencies. The demographic profile of the manufacturing engineering graduates from 2015 to 2019 is preserved and remains strictly confidential for the safety of their identification. Correspondingly, the study applied a cross-sectional retrospective survey method. Moreover, 67.41% of manufacturing engineering graduates responded. The employment rate of manufacturing engineering graduates was 93.38%, whereas regular or permanent in their current employment was 84.40%. Furthermore, data show that they are employed within less than a month, 50.97% of responses. Lastly, the primary learning competency that manufacturing engineering graduates consider is critical thinking skills, with a response rate of 86.11%, followed by problem-solving skills, with 81.94% responses, while third was communication skills, with a rate of 78.08%. Ultimately, the recommendations for further curriculum and program improvement are exhibited.</span>

Psychosocial Self-efficacy and its Association with Selected Potential Factors Among Adults with Type 1 Diabetes: A Cross-Sectional Survey Study.

The management of type 1 diabetes, a non-preventable chronic disease, leads to a high physical and psychological burden on the individual. Digital health technology can improve a person's psychosocial self-efficacy and thereby contribute to improved diabetes self-care. The aim of this study was to explore associations between psychosocial self-efficacy and demographic-, disease specific-, well-being as well as digital health technology (DHT) related factors among adults with type 1 diabetes. A primarily web-based cross sectional survey was conducted among adults with type 1 diabetes in Sweden (n = 301). Psychosocial self-efficacy was assessed using the Swedish version of the Diabetes Empowerment Scale, Swe-DES-23. The survey also contained questions related to demographic-, disease specific-, well-being as well as digital health technology related variables. Higher well-being scores and lower HbA1c levels were associated with higher psychosocial self-efficacy in multiple linear regression analysis. In multivariate analysis, gender, body mass index, well-being scores, and HbA1c levels showed association with psychosocial self-efficacy. None of the DHT factors were found associated with psychosocial self-efficacy. In this study, higher well-being score and lower self-reported HbA1c levels were associated with higher psychosocial self-efficacy in both univariate- and multivariate analysis and accounted for 30% of the variation in psychosocial self-efficacy in the regression model. Thus, measures to improve psychosocial self-efficacy in adults with type 1 diabetes may help maintain their psychological well-being and blood glucose control.

A cross-sectional survey of patients prescribed elemental feed in the UK

A cross-sectional survey of patients prescribed elemental feed in the UK

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

Syringe services programmes (SSPs) are an evidence-based strategy to reduce infectious diseases and deliver overdose prevention interventions for people who use drugs. They face regulatory, administrative, and funding barriers that limit their implementation in the US, though the federal government recently began providing funding to support these efforts. In this study we aim to understand whether the organisational characteristics of SSPs are associated with the provision of syringe and other overdose response strategies. We examine four outcomes using the National Survey of Syringe Services Programs (NSSSP) (N=472): syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation. These outcomes are assessed across three organizational categories of SSPs-those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding-while adjusting for community-level confounders. The proportion of SSPs by organizational category was 36% DPH, 42% CBOs with government funding, and 22% CBOs without government funding. Adjusting for community-level differences, we found that CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programmes maintained by the DPH. CBO SSPs have strong potential to expand overdose response services nationally, particularly if provided with sustained and adequate funding. Communities should aim to provide funding that does not hinder SSP innovation so they can remain flexible in responding to local needs. This study was supported by Arnold Ventures (20-05172).

Current gaps in emergency medicine core content education for oncologic emergencies: A targeted needs assessment.

The core content of emergency medicine (EM) residency training includes the management of oncologic emergencies; however, documented knowledge gaps continue to exist in this subtopic. This study represents a targeted needs assessment as indicated by Step 2 of Kern's curriculum design to determine the specific training gaps to be addressed within the oncologic EM curriculum. A multi-institutional cross-sectional survey of oncologists (surgical and medical) and emergency physicians (attendings and residents) was conducted during 2023 at five institutions. The voluntary survey consisted of general and specialty-specific questions exploring gaps in oncologic emergency-specific training/education topics. Descriptive statistics reported responses as frequencies and percentages. Of the 833 surveys sent across the five sites, 302 (36.3%) were accessed by link; of these, 271 (89.7%) surveys were completed. There were no differences in the responses between early and later respondents and no differences in the characteristics of respondents between sites. A vast majority of the oncologist and EM groups (91.2% and 83.0%, respectively) reported a belief that emergency physicians would benefit from additional oncologic emergency training. Our survey identified 16 important topics for inclusion in an oncologic EM curriculum, including five topics not present on the 2022 Model of Clinical Practice of Emergency Medicine. Based on this needs assessment, an oncologic EM curriculum should include the topics listed under oncologic emergencies in the 2022 Model of the Clinical Practice of Emergency Medicine along with our respondent-identified topics of radiation therapy adverse effects, stem cell transplant complications, and the management of cancer-specific postsurgical complications, pain, and common diseases in patients with cancer.

Prevalence of skin problems caused by insulin pump therapy and associated factors in children with type 1 diabetes mellitus: A large cross-sectional survey in China

AimsTo document the prevalence of skin problems associated with insulin pump use and identify contributing factors among children with type 1 diabetes mellitus in China. MethodsIn total, 461 children were recruited from an online community (i.e., a Wechat group) of pediatric patients with T1DM. A self-developed questionnaire was filled in by parents, collecting the information on social demographics, disease, and insulin pump therapy related characteristics and skin problems. We applied the Mann–Whitney U test, Chi square test and logistic regression analysis to identify the factors associated with skin problems. ResultsOf the 461 responders, 308 (66.8 %) children were reported to have skin problems. More specifically, 38.8 % had pigmentation changes, 22.3 % allergy/dermatitis, 20.2 % scaring, 11.5 % pain, 10.8 % infection, 10.6 % subcutaneous lipohypertrophy, and 6.1 % lipoatrophy. Logistic regression analysis showed that independent associated factors of skin problems were the caregiver’s educational level as college or above, patient having skin allergies, and using the Brand 2 insulin pump (p values < 0.05). ConclusionsThe present study documents the prevalence of skin problems and identifies associated factors, such as caregiver’s education, patients skin allergies, and using a specific brand of pump. Health education should address these factors in addition to the traditionally emphasized factors.

Expert opinion regarding early screening, patient awareness, and telemedicine practices in Indian settings

Objective: To collect clinicians’ perspectives regarding the significance of early screening, patient awareness, and telemedicine practice in routine Indian settings for diabetes management. Methodology: The study employed a 25-item questionnaire to gather insights from specialists across different Indian settings regarding their perspectives on early screening, patient awareness, and telemedicine practices among diabetologists. Results: According to the cross-sectional survey, 59% of respondents believed that regular awareness programs were helpful in the early screening of diabetes among high-risk individuals. Meanwhile, 64% of clinicians reported that clinical-level screening was a more effective tool for early screening. Around 74% of clinicians reported that microvascular complications namely diabetic retinopathy, diabetic neuropathy, and diabetic kidney diseases should be targeted during early screening of diabetes. The American Diabetes Association (ADA) risk score was the most commonly used risk score for early diabetes screening, according to 54% of clinicians. Moreover, 67% of clinicians reported that 11 to 25% of diabetic individuals had complications of lipitension, and 64% reported that 11 to 20% of T2DM individuals had depression. Regarding telemedicine, 65% of clinicians preferred to use it occasionally. However, at an individual level, factors like cost, literacy, less familiarity with using the tool, and emotional reasons hindered the effective adoption of telemedicine, as reported by 56% of clinicians. Conclusion: The survey highlighted the effectiveness of awareness programs and clinical-level screening for early diabetes management, emphasizing the importance of targeting microvascular complications. Increased prevalence of complications like lipitension and depression was noted in diabetic individuals. Telemedicine, though recognized as valuable, faces challenges due to individual-level factors.

Examining the Period-Based Changes in the Effect of Socioeconomic Status in Maternal Healthcare Utilization Across Regional and Residential Contexts in Postcolonial Tanzania (1991–2016)

ABSTRACT Applying dependency theory, this manuscript uses data from the six cross-sectional Tanzania Demographic Health Surveys from 1991 to 2016 (n = 30,028) to explore temporal variations in the effect of socioeconomic status (SES) on maternal healthcare (MHC) utilization across different residences and regions. Research in this area is nonexistent in Tanzania. The results suggest a notable gap in using Tanzanian MHC based on SES and location (i.e. residence, regions). Results suggest that women from underserved groups, such as those living in rural areas or all-other (i.e. unprivileged) regions with lower SES, may have less access to MHC in the underdeveloped world. There were statistically significant socioeconomic variations in MHC use observed between residencies and regions, with stronger differences seen between residencies than regions. These findings further highlight the idea that lower use of MHC in the Global South is inseparable from economic dependency on metropolitan and Global North countries. This research calls for policymakers to recognize the roles of interactions between location and socioeconomic inequalities as factors exacerbated by higher dependency when crafting policies to modify healthcare utilization among women in underdeveloped countries.

Urban-Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18).

Diabetes is a multifactorial disease with far-reaching consequences. Environmental factors, such as urban or rural residence, influence its prevalence and associated comorbidities. Haryana-a north Indian state-has undergone rapid urbanisation, and part of it is included in the National Capital Region (NCR). The primary aim of the study is to estimate the prevalence of diabetes in Haryana with urban-rural, NCR and non-NCR regional stratification and assess the factors affecting the likelihood of having diabetes among adults. This sub-group analysis of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study (a nationally representative cross-sectional population-based survey) was done for Haryana using data from 3722 participants. The dependent variable was diabetes, while residence in NCR/non-NCR and urban-rural areas were prime independent variables. Weighted prevalence was estimated using state-specific sampling weights and standardized using National Family Health Survey-5 (NFHS-5) study weights. Associations were depicted using bivariate analysis, and factors describing the likelihood of living with diabetes were explored using a multivariable binary logistic regression analysis approach. Overall, the weighted prevalence of diabetes in Haryana was higher than the national average (12.4% vs. 11.4%). The prevalence was higher in urban (17.9%) than in rural areas (9.5%). The prevalence of diabetes in rural areas was higher in the NCR region, while that of prediabetes was higher in rural non-NCR region. Urban-rural participants' anthropometric measurements and biochemical profiles depicted non-significant differences. Urban-rural status, age and physical activity levels were the most significant factors that affected the likelihood of living with diabetes. The current analysis provides robust prevalence estimates highlighting the urban-rural disparities. Urban areas continue to have a high prevalence of diabetes and prediabetes; rural areas depict a much higher prevalence of prediabetes than diabetes. With the economic transition rapidly bridging the gap between urban and rural populations, health policymakers should plan efficient strategies to tackle the diabetes epidemic.

"Time is a Big Factor": Aged-Care Workforce Perspectives on Communication Partner Training for Working With Residents With Dementia.

Many individuals who reside in permanent residential aged care (RAC) have a diagnosis of dementia, with the majority experiencing a communication disorder. Existing literature has placed an emphasis on the need for staff to undertake communication partner training. This study aimed to investigate the preferences of RAC staff, and their perceived barriers and facilitators to workplace training. Through an exploratory cross-sectional online survey, a sample of RAC workers in Australia were recruited (n = 104). Descriptive statistics revealed that the majority of participants preferred training to be delivered face to face and being paid for participation. Through content analysis of open-ended questions, seven categories were identified regarding perceived barriers and facilitators for communication partner training in the workplace. These included staff shortages, time pressures, remuneration and training delivery method, and quality of the educators. Additionally, management attitudes were pertinent. These findings may inform the development and outcomes of future communication partner training in RAC.

Related barriers to using HIV pre-exposure prophylaxis among MSM: A multicentre cross-sectional survey.

The objective of this study was to gain insight into the barriers hindering the use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in five cities in China. MSM were recruited via community-based organizations in an online "snowball" manner. Participants completed the questionnaire anonymously and shared it with key MSM peers (seeds) in five cities in China. Based on the results of univariate analysis, we used a structural equation model to analyse the role of PrEP knowledge awareness, PrEP counselling, and other behavioural variables on PrEP use. The study collected a total of 4223 valid questionnaires, and 18.2% of participants reported PrEP use. The results of the standardized total effects showed that the following paths were statistically significant (p < 0.05): from the age of first sex with men to PrEP knowledge awareness (β = -0.113) and PrEP use (β = 0.042); from high-risk sexual behaviour scores to PrEP counselling (β = 0.039) and PrEP use (β = 0.103); from the number of HIV tests in the last year to PrEP knowledge awareness (β = 0.034), PrEP counselling (β = 0.170), and PrEP use (β = 0.197); from the level of self-perceived risk of HIV infection to PrEP counselling (β = -0.115); from PrEP knowledge awareness to PrEP use (β = -0.049); and from PrEP counselling to PrEP use (β = 0.420). The proportion of PrEP use among MSM was relatively low. Age at first sex with men, number of HIV tests, high-risk sexual behaviour, and PrEP counselling had a positive effect on PrEP use, whereas PrEP knowledge awareness had an inverse effect on PrEP use.

People-Oriented Culture and its association with burnout, depressive symptoms, and sleep problems during COVID-19 pandemic among EMS providers in Korea.

This study examined how perceived people-oriented culture (POC) was associated with burnout, depressive symptoms, and sleep problems during the COVID-19 pandemic among emergency medical service (EMS) providers in Korea. We conducted a cross-sectional survey among 693 EMS providers in 2021. Overall, 60% reported burnout and around 25% had depressive symptoms. Prevalence of poor sleep quality, unrestful sleep, and sleep disturbance were 46.5%, 58.2%, and 52.2%, respectively. Compared to high POC group, higher prevalence of depressive symptoms was observed among medium (PR: 1.57, 95% CI: 1.06, 2.32) and low (PR: 2.70, 95% CI: 1.92, 3.79) POC group. Similar trends were observed in the analysis of burnout and sleep problems. Our findings underscore that low POC could play a critical role in worsening burnout, depressive symptoms, and sleep problems among EMS providers.

Accessibility of digital systems in information retrieval by users with visual impairment

Purpose This paper aims to evaluate the accessibility of digital information systems as a key usability attribute in information retrieval by users with visual impairment (VI), to inform development of accessible information systems. Design/methodology/approach This study used a cross-sectional survey design based on the quantitative research paradigm. Data was collected from 117 students with visual impairments from selected public universities in Kenya, using a semi-structured questionnaire adapted from Web Content Accessibility Guidelines. Findings This study revealed that gender did not influence screen reader compatibility, alternative format preferences, perceptions of accessible content or digital library navigability. Instead, type of visual impairment, prior assistive technology (AT) training and digital library use frequency significantly impacted these attributes. Blind students reported positive experiences, favouring alternative formats, and expressed positive views on accessible content while those with low vision faced more challenges. Prior training in assistive technology and frequent digital library use resulted in higher screen reader compatibility and better navigability. Increased digital library use was linked to access to alternative content for those with prior assistive technology training. Research limitations/implications This study contributes to the existing literature on accessibility of digital information systems for users with visual impairments. Further research is needed to explore other factors that may influence the accessibility of digital systems, such as the design of user interfaces as well as an evaluation of accessibility of digital systems for other categories of disabilities such as hearing impairment, physical impairment, autism and intellectual disability, among others. Practical implications The findings of this study have practical implications for the design and development of digital systems such as digital libraries. Developers can leverage findings of this study to enhance compatibility of digital platforms with screen readers and provide alternative formats and accessible content. User-centred design principles can be used to create interfaces that are easy to navigate and friendly to users with visual impairments. Training programmes on assistive technology should be provided to users to enhance their skills and confidence in using digital systems. Originality/value This study contributes towards design and creation of navigable systems that are compatible with screen readers. The study also points out the importance of creating more inclusive and usable digital environments for persons with visual impairments.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China

BackgroundThe World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.MethodsA cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.ResultsAmong the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).ConclusionsThe older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.