Slope Index Research Articles

Improving the identification of pollution source areas with catchment-resolution sensitivity analysis

The significant impacts of total nitrogen (TN) and total phosphorus (TP) on riverine ecosystems underscores the critical need to identify the primary nutrient source areas in watersheds. This study aims to unravel the influences of terrain and land use types on mean monthly TN (TNM) and mean monthly TP (TPM) export across varying catchment resolutions in the Qiantang River Watershed of China. The findings of this study illuminated the critical role of topography in understanding nutrient dynamics, wielding a profound influence over water flow patterns and nutrient dispersion. Both land slope and Stream Power Index (SPI) displayed substantial negative correlations (r < −0.6) with TNM and TPM concentrations, whereas the Topographic Wetness Index (TWI) showed positive correlations with the nutrient indexes. In addition to terrain characteristics, impervious land surfaces had a positive correlation with nutrient concentrations, while grassland and forest areas exhibited negative correlations. Results further underscored the substantial influence of catchment resolution on correlations between watershed properties and riverine nutrient concentrations. It was imperative to choose an effective catchment resolution in watershed delineation – not too coarse, nor too fine – to accurately capture the topographic and land use impacts on nutrient dynamics. With the most appropriate catchment size (Catchment 700 km2), the critical pollution source areas for TN and TP pollution were identified, and thus could be used to guide future pollution reduction efforts. The study not only highlights the importance of identifying an appropriate catchment size for water pollution, but also emphasizes the necessity of effectively extracting critical pollution source areas to mitigate water nutrient pollution and increase the ecological integrity of the Qiantang River Watershed.

Futuristic flood risks assessment, in the Upper Vellar Basin, integrating AHP and bivariate analysis

Flood susceptibility maps provide invaluable information for assessing and managing flood-prone areas, aiding in proactive planning, risk reduction strategies, and safeguarding vulnerable communities. The current research concentrates on advancing sustainable development practices by undertaking a comprehensive assessment of flood susceptibility in the Upper Vellar basin, with a projection for 2050. Employing an integrative methodology, this study utilizes an Analytical Hierarchy Process (AHP) and Bivariate Analysis. Nine critical parameters were used: elevation, distance from the river, distance from the road, drainage density, predicted LULC, projected precipitation, slope, soil type, and Topographic Wetness Index (TWI). The Modules of Land Use Change Evaluation (MOLUSE) plugin, which uses Cellular Automata-Artificial Neural Network (CA-ANN), was employed to predict the LULC map for the year 2050. Furthermore, bias-corrected Coupled Model Intercomparison Project 6 (CMIP 6) EC EARTH 3 Model (GCM) RCP 4.5 and 8.5 projected precipitation data were employed. The resulting flood susceptibility zones are classified into three categories: low, moderate, and high, with proportions of 32.64%, 55.52%, and 11.84% for RCP 4.5, and 34.63%, 53.46%, and 11.91% for RCP 8.5, respectively, concerning the total area. In both scenarios, nearly 38% of the settlement area is at high flood risk. This study provides essential insights for policymakers and stakeholders, facilitating the formulation of sustainable strategies to address projected changes in land use, precipitation patterns, and flood susceptibility in the Upper Vellar region up to 2050.

Disparities and Determinants of Testing for Early Detection of Cervical Cancer among Nepalese Women: Evidence from a Population-Based Survey.

Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women. Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake. Only 7.1% [95% confidence interval (CI): 5.1-9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4-7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8-21.9). Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals. Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.

Global disease burden attributable to kidney dysfunction, 1990–2019: A health inequality and trend analysis based on the global burden of disease study

ObjectiveThis study aimed to evaluate the burden of kidney dysfunction (KD), assess socioeconomic inequalities, and project trends in the future. MethodsData on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were from Global Burden of Disease Study 2019. The Joinpoint regression model was utilized to analyze the temporal trend by the annual percentage change (APC). The slope index and concentration index were employed to evaluate cross-country disparities. The future trend was predicted using an age-period-cohort analysis. ResultsIn the past three decades, the death numbers of KD increased from 1,571,720 to 3,161,552, DALYs from 42,090,331 to 76,486,945, YLDs from 5,003,267 to 11,282,484, and YLLs from 37,087,065 to 65,204,461, respectively. The age-standardized rate (ASR) of deaths, DALYs, and YLLs exhibited a declining trend. The ASR of YLDs increased until 2017, then decreased. The slope index and concentration index for DALYs increased from 248.1 to 351.9 and from 40.70 to 57.8. In the future, the ASR of deaths, DALYs, YLDs, and YLLs will remain stable, while their numbers will continue to rise, except for YLLs. ConclusionsThe disease burden of KD remained serious. Tailored interventions should be developed based on national contexts.

Direct and mediated impacts of mixed forests on Norway spruce infestation by European bark beetle Ips typographus

Climate change-induced windfalls and droughts exacerbate bark beetle outbreaks, severely impacting forest ecosystems. Despite extensive research on bark beetle infestation patterns, the question regarding the optimal spatial grid (SG) size for analyzing this phenomenon remains unresolved. The protective potential of natural forest complexity against bark beetles has been underestimated. We used remotely sensed data to fit Generalized Linear Models and structural equation models to explore the direct and environment-mediated effects of mixed forest cover (MFC) on Norway spruce forest infestation in central Europe. We assessed the effectiveness of various spatial grids (from 100 m to 1 km) for studying infestation by Ips typographus. We found a strong non-linear decline in infestation with increasing MFC across different spatial scales. The relationship between infestation and temperature was positive, while elevation had a negative effect on infestation, with higher infestation rates observed below 900 m. Direct effects of environmental predictors on infestation were significant at SGs of 100 m, 300 m, 400 m, and 500 m, but insignificant at 200 m and 1000 m SGs. Slope positively influenced infestation at 300 m and 400 m SGs. MFC exhibited significant indirect effects on infestation mediated by elevation, temperature, potential evapotranspiration, slope, and heat load index. Landscape variables played a significant role in the models at high-resolution spatial grids, whereas climate variables were influential in models at lower spatial grids of infestation data. We argue that mixed forest facilitates cooling, preserves water, enriches symbiotic fungal community, alleviating tree drought stress and mitigating infestation risk. Broad-leave trees’ non-host volatiles presumably disrupt olfactory signals, impeding beetles’ ability to locate host trees effectively. Our results underscore the potential of increasing mixed forest cover as a self-sustainable silvicultural measure for forest protection against I. typographus and for mitigating the effects of climate change.

Ethnic inequalities in coverage and use of women’s cancer screening in Peru

ObjectiveThis study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru.MethodsData from the 2017–2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups.ResultsThe study included 70,454 women aged 30–69. Among women aged 40–69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and − 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and − 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education.ConclusionEthnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas.

Obesity and dental caries in childhood: trends in prevalence and socioeconomic inequalities—a multicohort population-wide data linkage study

ObjectivesTo quantify levels of coexisting obesity and caries experience in children in Scotland, and any associated socioeconomic inequalities over the years 2011/2012–2017/2018.DesignA multicohort population-wide data linkage study.SettingLocal authority primary schools...

Twelve–year (2008–2019) trends in socioeconomic inequalities in cardiovascular risk factors in a Swiss representative survey of the general population

ObjectiveWe assessed trends in socioeconomic inequalities in cardiovascular risk factors prevalence among Swiss adults from 2008 to 2019. MethodsUsing data from the Bus Santé study, an annual survey of adults living in Geneva, Switzerland, we calculated the prevalence per period and by demographic and socioeconomic indicators, assessing inequality trends using the relative index of inequality (RII) and the slope index of inequality (SII). ResultsAmong 10,739 participants, most CVD risk factors decreased over time, while diabetes, obesity, and smoking prevalence remained steady. In 2017–2019, prevalence of most CVD risk factors was higher in socioeconomically disadvantaged groups. Relative and absolute inequalities decreased over time, but mostly remained, for hypertension [in 2017–2019, education-RII (95 % CI) = 1.27 (1.12–1.46), income-RII = 1.27 (1.10–1.47)], hypercholesterolemia [education-RII = 1.15 (1.00–1.32)], and sedentarity [education-RII = 1.95 (1.52–2.51), income-RII = 1.69 (1.28–2.23)], and appeared to have reversed for hazardous alcohol use [income-RII = 0.75 (0.60–0.93)]. Substantial and persistent relative and absolute inequalities in diabetes prevalence were observed [education-RII = 2.39 (1.75–3.27), income-RII = 3.18 (2.25–4.48), and subsidy-RII = 2.77 (1.89–4.05)]. Inequalities were also marked across all socioeconomic indicators for obesity prevalence [education-RII = 3.32 (2.63–4.19), income–RII = 2.37 (1.85–3.04), subsidy-RII = 1.98 (1.48–2.66)] and for smoking [education-RII = 2.42 (2.06–2.84), income-RII = 2.37 (1.99–2.84), subsidy-RII = 1.91 (1.56–2.35)]. ConclusionsOver 12 years in Geneva, Switzerland, socioeconomic inequalities in hypertension, hypercholesterolemia, hazardous alcohol use, and sedentarity decreased but persist, while substantial inequalities in diabetes, obesity, and smoking remained unchanged.

Global burden and cross-country inequalities in stroke and subtypes attributable to diet from 1990 to 2019

Data sourcesThe Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019.BackgroundTo describe burden, and to explore cross-country inequalities according to socio-demographic index (SDI) for stroke and subtypes attributable to diet.MethodsDeath and years lived with disability (YLDs) data and corresponding estimated annual percentage changes (EAPCs) were estimated by year, age, gender, location and SDI. Pearson correlation analysis was performed to evaluate the connections between age-standardized rates (ASRs) of death, YLDs, their EAPCs and SDI. We used ARIMA model to predict the trend. Slope index of inequality (SII) and relative concentration index (RCI) were utilized to quantify the distributive inequalities in the burden of stroke.ResultsA total of 1.74 million deaths (56.17% male) and 5.52 million YLDs (55.27% female) attributable to diet were included in the analysis in 2019.Between 1990 and 2019, the number of global stroke deaths and YLDs related to poor diet increased by 25.96% and 74.76% while ASRs for death and YLDs decreased by 42.29% and 11.34% respectively. The disease burden generally increased with age. The trends varied among stroke subtypes, with ischemic stroke (IS) being the primary cause of YLDs and intracerebral hemorrhage (ICH) being the leading cause of death. Mortality is inversely proportional to SDI (R = -0.45, p < 0.001). In terms of YLDs, countries with different SDIs exhibited no significant difference (p = 0.15), but the SII changed from 38.35 in 1990 to 45.18 in 2019 and the RCI showed 18.27 in 1990 and 24.98 in 2019 for stroke. The highest ASRs for death and YLDs appeared in Mongolia and Vanuatu while the lowest of them appeared in Israel and Belize, respectively. High sodium diets, high red meat consumption, and low fruit diets were the top three contributors to stroke YLDs in 2019.DiscussionThe burden of diet-related stroke and subtypes varied significantly concerning year, age, gender, location and SDI. Countries with higher SDIs exhibited a disproportionately greater burden of stroke and its subtypes in terms of YLDs, and these disparities were found to intensify over time. To reduce disease burden, it is critical to enforce improved dietary practices, with a special emphasis on mortality drop in lower SDI countries and incidence decline in higher SDI countries.

Spatio-temporal modeling of lake's ecosystem and dynamism in response to changing environment: a case study of L. Ol Bolossat in Kenya.

Lakes' ecosystems are vulnerable to environmental dynamisms prompted by natural processes and anthropogenic activities happening in catchment areas. The present study aimed at modeling the response of Lake Ol Bolossat ecosystem in Kenya to changing environment between 1992 to 2022 and its future scenario in 2030. The study used temperature, stream power index, rainfall, land use land cover, normalized difference vegetation index, slope, and topographic wetness index as datasets. A GIS-ensemble modeling approach coupling the analytical hierarchical process and principal component analysis was used to simulate the lake's extents between 1992 and 2022. Cellular Automata-Markov chain analysis was used to predict the lake extent in 2030. The results revealed that between 1992 and 2002, the lake extent shrunk by about 18%; between 2002 and 2012, the lake extent increased by about 13.58%; and between 2012 and 2022, the lake expanded by about 26%. The spatial-temporal changes exhibited that the lake has been changing haphazardly depending on prevailing climatic conditions and anthropogenic activities. The comparison between the simulated and predicted lake extents in 2022 produced Kno, Klocation, KlocationStrata, K standard, and average index values of 0.80, 0.81, 1.0, 0.74, and 0.84, respectively, which ascertained good performance of generated prediction probability matrices. The predicted results exhibited there would be an increase in lake extent by about 13% by the year 2030. The research findings provide baseline information which would assist in protecting and conserving the Lake Ol Bolossat ecosystem which is very crucial in promoting tourism activities and provision of water for domestic and commercial use in the region.

The global, regional, and national patterns of change in the burden of non-malignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade.

Non-malignant upper gastrointestinal diseases, including peptic ulcer disease (PUD), gastritis and duodenitis (GD), and gastroesophageal reflux disease (GERD), significantly challenge global healthcare. These conditions not only impact patient health but also highlight socio-economic development issues and healthcare system accessibility and efficiency. Utilizing the Global Burden of Disease (GBD) database, this study aims to assess the global burden of PUD, GD, and GERD comprehensively, examining their association with the sociodemographic index (SDI). Employing data from the GBD 2019 database, this study analyzed the disability-adjusted life years (DALYs) for PUD, GD, and GERD. We integrated the SDI with the inequality slope index and concentration index for an international health inequality analysis, assessing disparities in the burden of these non-malignant upper gastrointestinal diseases. Decomposition analysis was conducted to determine the effects of population growth, aging, and epidemiological shifts on disease burden. Frontier analysis was performed to identify potential improvement areas and disparities among countries by development status. Disease time trends were depicted using a Joinpoint regression model, and the Bayesian age-period-cohort (BAPC) model projected the disease burden up to 2030. Between 1990 and 2019, the age-standardized DALYs rates (ASDR) for non-malignant upper gastrointestinal diseases declined. However, global geographic heterogeneity remained evident, closely linked to the SDI. Notably, low-SDI countries experienced higher disease burdens. Population growth and aging emerged as principal contributors to the increasing disease burden. Despite development levels, many countries have considerable potential for reducing the burden of these diseases. Furthermore, significant variations in the time trends of non-malignant upper gastrointestinal diseases were observed among countries and regions with different SDI levels, a pattern expected to continue through 2030. Non-malignant upper gastrointestinal diseases demonstrate notable heterogeneity across age, gender, and geography, with the disparities most marked in underdeveloped regions or countries. Consequently, it is imperative to focus research on policy development and to enact prevention and treatment strategies tailored to high-risk groups. This targeted approach is essential for mitigating the disease burden effectively.

Spatial Differentiation Characteristics, Driving Mechanisms, and Governance Strategies of Rural Poverty in Eastern Tibet

Rural areas in Tibet, with its complex terrain, fragile ecology, and poor facilities, are subject to a combination of social–ecological system elements, facing the typical risks of recurrent, marginal, and potential poverty. At present, the spatial differentiation and driving mechanism of rural spatial poverty risk in Tibet are not clear, which adversely affects the formulation of differentiated and precise governance strategies. Thus, based on the social–ecological system perspective, 967 poor rural villages in eastern Tibet were taken as an example, using intelligent techniques such as random forest, geographic detector, and multi-scale geographically weighted regression to identify the spatial differentiation characteristics and the driving mechanism of poverty. The results indicated that (1) the high poverty incidence of rural areas in eastern Tibet showed a scattered block distribution, of which approximately 37% of the villages presented a spatial distribution characterised by a high degree of clustering of the high poverty incidence. (2) Topography and the level of public facilities were key factors influencing the poverty levels of rural areas in eastern Tibet, in which the coupling explanatory power between the construction land slope index (CLSI) and several poverty-causing factors was high. (3) Geological disaster, land surface temperature, CLSI, traffic accessibility, livestock resources, cropland per capita, and tourism resources differentially drove the poverty incidence of rural areas in eastern Tibet, forming spatial partitions dominated by the risks of potential, marginal, and recurrent poverty. For different partitions, differentiated governance strategies of upgrading ecological environments, optimising geographical locations, and revitalising social resources were proposed to provide references for solving the problem of relative poverty in the new period.

Constraints of geomorphic indices on the expansion mode of the southeastern margin of the Tibetan plateau

The growth and expansion of the southeastern Tibetan Plateau remain contentious. Positioned as one of the regions characterized by the most robust tectonic activities on the plateau, the southeastern edge provides a distinctive setting for investigating plateau uplift and landform evolution. This study focuses on the southeastern margin of the plateau in the Three Rivers Region, conducting comprehensive analyses of slope, relief, hypsometric integral (HI), and channel steepness index (ksn). We use this new dataset to highlight the more significant role of tectonic activities in shaping the landform compared to climate and lithology. By examining the spatiotemporal characteristics of long-term and short-term rock exhumation rates, derived from low-temperature thermochronology and cosmogenic nuclide 10Be analysis, we establish a correlation between erosion rates and ksn, slope, and terrain undulation. Integrating this information with geophysical evidence and GPS data, we support the model for the expansion of the southeastern edge—the steady-state terrain crustal flow model. According to this model, there is an equilibrium achieved between rock uplift and surface erosion on the southeastern edge of the Tibetan Plateau. Despite ongoing southeastward extrusion of plateau material, the overall plateau morphology remains unaltered due to intense erosion along the plateau’s edge. Consequently, the large-scale topographic expansion of the southeastern Tibetan Plateau has effectively halted.

Poster 352: Histopathological Etiology of Mucoid Degeneration of the Anterior Cruciate Ligament

Objectives: Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon clinical condition with reported prevalence below 0.5%. There is a paucity of histopathological description in the literature, which has limited our understanding of the underlying pathophysiology. Such limited understanding has resulted in treatment options limited to mechanical debridement rather than biologic interventions to prevent development or progression of mucoid degeneration. The purpose of this study is to define the histopathology of mucoid degeneration of the ACL to better guide future biologic and surgical management options. Methods: This is a case control study where a retrospective series of 10 patients were identified to have mucoid degeneration of the ACL from 2002 to 2023. They were evaluated and treated by two senior attending orthopedic sports medicine surgeons. Magnetic resonance images (MRI) were evaluated for multiple anatomic and morphometric measures. Tissue samples were obtained at the time of arthroscopic partial debridement of the ACL for all patients. Intra-operative ACL samples and cadaveric control tissues were prepared for histologic examination of microstructure and composition, and gene expression using multiplex transcriptional profiling. For the gene expression analysis RNA was isolated from archived formalin-fixed and paraffin-embedded (FFPE) sections. Three consecutive 6mm sections were pooled to generate one RNA sample and total RNA was extracted using a High Pure FFPET RNA Isolation Kit per the manufacturer’s protocol and stored at -80°C until further analysis. RNA concentration and integrity was evaluated using an Agilent BioAnalyzer 2100 and a corrected input of 50ng of total RNA was used for NanoString analyses using the NanoString nCounter® Human Fibrosis V2 Panel for multiplex molecular analysis of 770 genes. Analysis was performed using nSolver 4.0 Software and only probes with counts above background were included following the manufacturer instructions. Results: All 10 patients reported pain and limited knee flexion. MRI exhibited a bulbous appearance of the ACL. There was an increased posterior tibial slope (PTS), narrow notch width index, and increased signal intensity of the ACL. Medial meniscus tear and cartilage degeneration were reported with high prevalence. The histological analysis showed significant differences in the architecture of the tissue compared with normal ACL controls, with disorganized collagen matrix and increased glycosaminoglycan content. NanoString analysis demonstrated a total of 155 differentially expressed genes (DEGs) between the mucoid degeneration and control groups after adjustments for multiple comparisons (p&lt;0.05), with the top 20 DEGs summarized in Table 1. Among all the DEGs identified the 5 most upregulated ones include Fibronectin 1 (FN1), COL5A1, COL6A3, COL3A1 and COL1A2. There were also significant differences in the pathway scores for epithelial-to-mesenchymal transition (EMT), Extracellular matrix Degradation and Synthesis, Collagen Biosynthesis, Focal Adhesion Kinase, PDGF Signaling and PI3K-Akt (Fig. 1). The histology findings demonstrate distinct changes in the structure and composition of the ACL, and we hypothesize that repetitive microtrauma of the ACL may lead to cumulative damage that ultimately results in mucoid degeneration. Increased posterior tibial slope and narrow notch width index may contribute to cumulative loading of the ligament and subsequent mucoid degeneration. Identification of biomechanical risk factors may help to identify high risk patients. Associated injury of the medial meniscus and medial compartment cartilage also suggests that mucoid degeneration of the ACL may be part of an early degenerative process in the knee. Conclusions: Mucoid degeneration of the ACL is an uncommon condition that may represent the result of repetitive microtrauma to the ligament. Current interventions address the condition after it has progressed to an irreversible biological state. By defining the cellular and molecular mechanism(s) of the condition, we aim to broaden treatment options to potentially identify biologic interventions. The association of mucoid degeneration and medial compartment osteoarthritis suggests that patients may benefit from earlier interventions. [Figure: see text][Figure: see text]

Population assessment of health system performance in 16 countries.

To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.

Individual, social and area level factors associated with older people's walking: Analysis of an UK household panel study (Understanding Society)

BackgroundAmong older people, walking is a popular and prevalent activity. Walking is key to increasing physical activity levels and resulting physical and mental health. In the context of rapidly ageing populations, it is important to better understand what factors are associated with walking among older people, based on the socioecological model of health. MethodsWe used data from Understanding Society (n:6450), a national panel survey of UK adults aged 65 years and over living in Great Britain. Slope Indices of Inequality (SII) were calculated for weekly walking hours for older people according to individual, social and area characteristics. These include health, loneliness and social isolation, previous walking and sporting activity, residential self-selection, contact with neighbours, number of close friends and social activity. Spatial area-level data described local area crime, walkability, and proximity to retail, greenspace, and public transport amenities. ResultsMultivariable models indicated that poor health, particularly requiring help with walking, was the strongest predictor of weekly walking hours (SII (95% CI) comparing those needing help vs. no help: −3.58 (−4.30, −2.87)). However, both prior sporting activity (most vs. least active: 2.30 (1.75, 2.88)) and walking for pleasure (yes vs. no: 1.92 (1.32, 2.53)) were strongly associated with increased walking several years later. Similarly having close friends (most vs. fewest, 1.18 (0.72, 1.77)) and local retail destinations (any vs. none: 0.93 (0.00, 1.86)) were associated with more weekly walking. ConclusionsPast engagement in physical activity and walking for pleasure are strong predictors of walking behaviour in older people, underscoring the importance of implementing and sustaining walking interventions across the lifespan to ensure continued engagement in later years and the associated health benefits. However, poor health significantly impedes walking in this demographic, emphasising the need for interventions that offer both physical assistance and social support to promote this activity.

When in the lifecourse? Socioeconomic position across the lifecourse and biological health score

PurposeEducational attainment is associated with multiphysiological wear and tear. However, associations with measures of socioeconomic position (SEP) across different life-stages are not established. MethodsUsing regression models and data from 8105 participants from the UK Household Longitudinal Study (Understanding Society), we examined associations of lifecourse SEP with an overall biological health score (BHS). BHS is broader than usual measures of biological ‘wear and tear’ and is based on six physiological subsystems (endocrine, metabolic, cardiovascular, inflammatory/immune, liver, and kidney), with higher scores indicating worse health. Lifecourse SEP was based on respondents’ parental, first, and most recent occupations. ResultsAssociations with SEP at all life-stages demonstrated higher BHS with increasing disadvantage (e.g. slope index of inequality (SII) (95 % CI) for most recent SEP: 0.04 (0.02, 0.06)). There was little difference in the magnitude of associations for SEP measured at each life-stage. Cumulative disadvantage across the lifecourse showed a stepped association with increasing BHS (SII (95 % CI): 0.05 (0.04, 0.07)). Associations were largely driven by metabolic, cardiovascular, and inflammatory systems. ConclusionOur results suggest that disadvantaged SEP across the lifecourse contributes cumulatively to poorer biological health, highlighting that every life-stage should be a target for public health policies and intervention.

Provincial inequality of China's progress towards universal health coverage: An empirical analysis in 2016-21.

Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies. Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII). From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention. In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.

Contingent magnetic variation and beta-band oscillations in sensorimotor temporal decision-making

The ability to accurately encode the temporal information of sensory events and hence to make prompt action is fundamental to humans’ prompt behavioral decision-making. Here we examined the ability of ensemble coding (averaging multiple inter-intervals in a sound sequence) and subsequent immediate reproduction of target duration at half, equal, or double that of the perceived mean interval in a sensorimotor loop. With magnetoencephalography (MEG), we found that the contingent magnetic variation (CMV) in the central scalp varied as a function of the averaging tasks, with a faster rate for buildup amplitudes and shorter peak latencies in the “half” condition as compared to the “double” condition. ERD (event-related desynchronization) -to-ERS (event-related synchronization) latency was shorter in the ”half” condition. A robust beta band (15–23 Hz) power suppression and recovery between the final tone and the action of key pressing was found for time reproduction. The beta modulation depth (i.e., the ERD-to-ERS power difference) was larger in motor areas than in primary auditory areas. Moreover, results of phase slope index (PSI) indicated that beta oscillations in the left supplementary motor area (SMA) led those in the right superior temporal gyrus (STG), showing SMA to STG directionality for the processing of sequential (temporal) auditory interval information. Our findings provide the first evidence to show that CMV and beta oscillations predict the coupling between perception and action in time averaging.

Global, regional, and national health inequalities of Alzheimer’s disease and Parkinson’s disease in 204 countries, 1990–2019

BackgroundAlzheimer’s disease and related dementias (ADRD) and Parkinson’s disease (PD), pose growing global health challenges. Socio-demographic and economic development acts paradoxically, complicating the process that determines how governments worldwide designate policies and allocate resources for healthcare.MethodsWe extracted data on ADRD and PD in 204 countries from the Global Burden of Disease 2019 database. Health disparities were estimated using the slope index of inequality (SII), and concentration index (CIX) based on the socio-demographic index. Estimated annual percentage changes (EAPCs) were employed to evaluate temporal trends.ResultsGlobally, the SII increased from 255.4 [95% confidence interval (CI), 215.2 to 295.5)] in 1990 to 559.3 (95% CI, 497.2 to 621.3) in 2019 for ADRD, and grew from 66.0 (95% CI, 54.9 to 77.2) in 1990 to 132.5 (95% CI, 118.1 to 147.0) in 2019 for PD; CIX rose from 33.7 (95% CI, 25.8 to 41.6) in 1990 to 36.9 (95% CI, 27.8 to 46.1) in 2019 for ADRD, and expanded from 22.2 (95% CI, 21.3 to 23.0) in 1990 to 29.0 (95% CI, 27.8 to 30.3) in 2019 for PD. Age-standardized disability-adjusted life years displayed considerable upward trends for ADRD [EAPC = 0.43 (95% CI, 0.27 to 0.59)] and PD [0.34 (95% CI, 0.29 to 0.38)].ConclusionsGlobally, the burden of ADRD and PD continues to increase with growing health disparities. Variations in health inequalities and the impact of socioeconomic development on disease trends underscored the need for targeted policies and strategies, with heightened awareness, preventive measures, and active management of risk factors.