Urban Employee Research Articles

PHP5 - From Per-Diem Payment to Case-Based Per-Episode Payment for Acute Mental Disorders in Guangzhou, China: A Propensity Score Matching and Difference-in-Differences Analysis Using Real World Data

Title: From per-diem payment to case-based per-episode payment for acute mental disorders in Guangzhou, China: A propensity score matching and difference-in-differences analysis using real world data Authors: Jingmei Xie1, Tiantian Zhang1, Sen Wang1, Jeff Jianfei Guo2, Jie Jiang1,3 1 College of Pharmacy, Jinan University, Guangzhou, 510632, P. R. China 2 College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA 3 Institute of Dongguan, Jinan University, Dongguan 523808, P. R. China Abstract: The case-based per-episode payment policy has been initiated in Guangzhou, a major city in China, since 2015 for patients with acute mental disorders such as schizophrenia, depression, and bipolar disorder. This study evaluated the economic impact of per-episode payment policy whether aggregated payment with per-diem for chronic patients and case-based per-episode for acute patients is more cost-saving than traditional payment with per-diem for both chronic and acute patients. A total of 6,778 episodes of medical records from Feb 1, 2014 to Feb 1, 2016, including 2,091 patients in one intervention hospital and 4,687 patients in ten control hospitals were extracted from Guangzhou Urban Employee Basic Medical Insurance. Length of stay, the number of hospitalization and medical expenditures per year were compared between groups. The total medical expenditures were calculated as a sum of medical insurance reimbursement and patient out-of-pocket payments. Economic impact was assessed using propensity score matching (PSM) plus difference-in-differences (DID) method. From governmental health insurance perspective, significant reductions in intervention group were observed in relevant economic outcomes per year per capita, including length of stay reduced 14.11 days (P=0.037), number of hospitalization reduced 0.02 times (P=0.04), medical insurance reimbursement reduced US$439.4 (P=0.017), patient out-of-pocket payments reduced US$242.4 (P<0.01), total medical expenditures reduced US$681.8 (P=0.002). The new payment policy was proved cost-saving and may facilitate acute mental disorder patients’ prognosis.

PDB15 - Budget Impact Analysis of Dapagliflozin for the Treatment of Type 2 Diabetes Mellitus in China

To estimate the potential budget impact of dapagliflozin as an alternative in treating T2DM from Chinese payer’s perspective. An Excel-based budget impact model was developed to compare the differences of annual health insurance expenditure in two scenarios which were listing dapaglifozin or not in national reimbursement drug list (NRDL) over a 5-year time horizon (2018-2022). Target population was calculated according to China Statistical Yearbooks and epidemiology statistics of T2DM in China, then divided into two programs of Urban Employee Basic Medical Insurance (UEBMI) or Urban and Rural Resident Basic Medical Insurance (URRBMI), respectively. The model assumed an increasing market share of dapagliflozin with a consequent decreasing of branded drugs of alpha-glucosidase inhibitors, sulfonylureas and DPP-4 inhibitors according to expert opinions and IMS market monitoring data. Both drug costs and medical costs associated with adverse events (AEs), which were severe hypoglycemia, major adverse cardiovascular events, and hospitalization for heart failure or renal diseases, were considered in the model. Drug costs were calculated by daily dosages, unit prices and days of utilization. The incidence and annual medical costs of AEs were derived from published literature. If dapagliflozin was listed in NRDL, the number of T2DM patients treated with dapagliflozin was increased from 0.16 to 1 million from 2018 to 2022. The estimated incremental annual health insurance expenditure would be +$10.44, +$20.81, +$37.56, +$27.67 and -$1.21 million for years 2018 to 2022, respectively. Because of the lower rates of AEs, especially of cardiovascular events, the cost-savings of AEs exceeded the incremental drug costs among patients with dapagliflozin in 2022. One-way sensitivity analyses indicated the results did not change dramatically when parameters varied. Listing dapagliflozin in NRDL may have a modest increasing impact of short-term budget while would lead to long-term net cost-savings caused by lower rates of AEs, especially the long-term cardiovascular benefits.

Screening, Salt Iodization and the Epidemic of Thyroid Cancer in China: An Analysis of National Inpatient and Commercial Insurance Databases

Background: Reasons behind the rapid increase of thyroid cancer (TC) in China are uncertain. Using two national databases, we assessed the burden of TC and the role of access to screening and salt iodization. Methods: We analyzed data from Hospital Quality Monitoring System (HQMS) with 76,263,617 class 3 hospital inpatients in 2013-2017 and China Reinsurance Company (CRC) database with 93,123,018 clients in 2000-2016. Level of access to screening was assessed by the type of medical insurance of individuals and provincial Per Capita Disposable Income (PCDI). Iodine status of provinces was estimated by median urinary iodine (MUI). The proportion of TC inpatients among inpatients in HQMS and TC incidence in CII buyers were used to evaluate the association with screening and iodine status. We used the HQMS to estimate TC incidence in the general population. Findings: Between 2013 and 2017 the proportion of TC patients in HQMS with urban employee medical insurance increased sharply while there was little change among those with the other two forms of medical insurance. The estimated incidence increased by 39.7% (23.9/100,000 to 33.4/100,000), with 1.98m new cases in class 3 hospitals. In CII buyers, the incidence increased by 57.2% (17.3/100,000 to 27.2/100,000) in 2013-2016. Across provinces, there was positive correlation between the proportion of TC inpatients in HQMS and PCDI. We found no association between the proportion of TC inpatients in HQMS in 2013-2017 and MUI in 1999 and 2005, but a negative correlation with MUI in 2011. Similar findings were observed in the CRC database. Interpretation: The epidemic of TC in China was substantially underestimated. It was associated with access to screening but not with salt iodization. In the absence of a very sharp reduction in screening activities, we forecast that 5.8 million healthy individuals would become TC patients unnecessarily between 2019 and 2030. Funding: The World Health Organization (WHO Reference 2016/648722-0 and 2017/722356-0 for the China-World Health Organization Biennial Collaborative Projects 2016-2017) and National Natural Science Foundation of China (81772850). Declaration of Interest: We declare no competing interests. Ethical Approval: The ethics committee of the First Affiliated Hospital of Sun Yat-sen University approved the study.

Chinese residents’ educational disparity and social insurance coverage

PurposeThe Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform.Design/methodology/approachUsing the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.FindingsThe authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals.Practical implicationsThe Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity.Originality/valueThis study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

Ambient air pollution and daily hospital admissions: A nationwide study in 218 Chinese cities

There have been few large multicity studies to evaluate the acute health effects of ambient air pollution on morbidity risk in developing counties. In this study, we examined the short-term associations of air pollution with daily hospital admissions in China. We conducted a nationwide time-series study in 218 Chinese cities between 2014 and 2016. Data on daily hospital admissions counts were obtained from the National Health Insurance Database for Urban Employees covering 0.28 billion enrollees. We used generalized additive model with Poisson regression to estimate the associations in each city, and we performed random-effects meta-analysis to pool the city-specific estimates. More than 60 million hospital admissions were analyzed in this study. At the national-average level, each 10 μg/m3 increase in PM10, SO2, and NO2, and 1 mg/m3 increase in CO at lag 0 day was associated with a 0.29% (95% CI, 0.23%–0.36%), 1.16% (95% CI, 0.92%–1.40%), 1.68% (95% CI, 1.40%–1.95%), and 2.59% (95% CI, 1.69%–3.50%) higher daily hospital admissions, respectively. The associations of air pollution with hospital admissions remained statistically significant at levels below the current Chinese Ambient Air Quality Standards. The effect estimates were larger in cities with lower air pollutants levels or higher air temperatures and relative humidity, as well as in the elderly. In conclusion, our findings provide robust evidence of increased hospital admissions in association with short-term exposure to ambient air pollution in China.

Work-Family Conflicts: Assessing a South African Sample of Urban Employees

The article explores the scope and impact of employees’ work responsibilities on the family life and vice-versa. It describes the coping styles adopted by a sample of urban employees and the efficacies of these styles. A semi-structured questionnaire and in-depth interviews were the means of collecting data from 48 respondents who were either dual career couples or single parents. The findings reveal that virtually all the respondents experience serious work-family conflicts, especially with managing their time, domestic chores, and stress. The challenge is for the employer, the employee, trade unions and partners to support each other to alleviate work-family conflicts. The findings are important given the focus of South African government on emancipating and empowering women through legislation and the setting up of national women. The contributions of women would be undermined, if family-work conflicts such as identified here were not addressed.

The association of multimorbidity with healthcare expenditure among the elderly patients in Beijing, China

ObjectivesTo add evidence to the relationship between multimorbidity and healthcare expenditure. MethodsThe study population comprised patients aged ≥60 in Beijing, covered by the Urban Employee Basic Medical Insurance (UEBMI) (N = 30,774). Multimorbidity was measured with 33 chronic conditions confirmed by doctors. Multivariate linear regression was performed. ResultsThe prevalence of multimorbidity was 82% among elderly patients in Beijing and was higher in older and female patients. About 95% of the healthcare expenditure on the 33 conditions was spent on multimorbid patients. In the multivariate analysis, after inclusion of demographic characteristics, disease severity, and health facility level, the expenditure increased significantly with the number of chronic conditions. After further including condition types, the coefficients of the number of conditions were much lower than those in previous models. The expenditure on patients with two and three conditions was 3.4 times (95% CI: 3.2–3.7) and 5.3 times (95% CI: 4.7–6.0) higher than that on patients with a single condition, respectively; however, the expenditure did not significantly increase after three conditions. ConclusionsMultimorbidity is common among elderly patients in Beijing and consumes the majority of the healthcare resources. The health delivery system in China and other low- and middle-income countries needs to pay more attention to multimorbidity.

Reducing the medical economic burden of health insurance in China: Achievements and challenges.

The aims of this study were to describe health insurance reforms initiated by the Chinese government over the past two decades, to review their achievements in reducing the medical economic burden, and to summarize the challenges that still exist regarding a further reduction in out-of-pocket expenditures in this country. China has successfully attained the goal of providing health insurance coverage to almost the entire population by developing a mixed health insurance system, which consists of Urban Employees Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NCMS), and supplementary Catastrophic Health Insurance. Despite this achievement, China is still facing the challenges of a disparity in the medical economic burden by region and by health insurance scheme, relatively little protection from financial risk compared to developed countries, as well as low efficiency and quality of care under current payment systems. To further reduce the disparity in the medical economic burden and to increase the overall protection from financial risk in China, the Government should increase central government transfers to NCMS and URBMI enrollees in poor regions and increase the total amount of government subsidies to NCMS. In addition, China should improve the efficiency and quality of health insurance by further reforming the payment system.

Equity of outpatient service utilization for hypertensive patients in community

To analyze the equity of outpatient service utilization for hypertensive patients (HPs) under 3 kinds of social medical insurance, and to explore its influential factors. Methods: A total of 8 670 HPs (aged at 15 years old from 28 sub-centers) in 14 provinces were selected. Indirectly standardized method and concentration index were used to analyze the equity of outpatient utilization in HPs, and decomposition analysis was used to explore the impact factors of outpatient treatment among the whole sample population, population with urban employees' basic medical insurance (UEBMI), and population with urban residents' basic medical insurance (URBMI) and new rural cooperative medical systems (NCMS). Results: The overall concentration index (CI) for the whole sample population was 0.2378. After the standardizing "need" variable, horizontal inequity (HI) was 0.2360, indicating that the outpatient service of HPs was inequity and that the higher economic level, the more outpatient services received. The decomposition of overall CI results showed that the positive factors for contribution were gross domestic product (GDP) level, retired, UEBMI and URBMI, and the negative factors for contribution were NCMS. The CI of UEBMI, URBMI and NCMS was 0.2017, 0.1208 and 0.0288, respectively; the HI was 0.1889, 0.1215 and 0.0219, respectively. The inequity in UEBMI is the most serious, followed by NRCMS and URBMI. The economic level was the main factor that caused inequity in the outpatient services utilization in three social medical insurance. In addition to the economic level, a common positive factor for the contribution to UEBMI and URBMI was district of residence, and the age was the positive factor to UEBMI as well. Conclusion: There are different levels of inequity in the HPs covered by 3 kinds of social medical insurance, and the inequity of UEBMI is the highest one among 3 kinds social medical insurance. The economic level is the main factor that affects the equity of outpatient in the HPs under 3 kinds of social medical insurance.

Non-communicable disease risk factor profile among public employees in a regional city in northern Ethiopia

The burden of non-communicable diseases (NCDs) is increasing in Ethiopia. This study aims to describe the prevalence of NCD risk factors of public employees in a regional city in northern Ethiopia. We conducted a cross-sectional epidemiological study targeting men and women aged 25–64 years employed by public offices in Mekelle. The prevalence was age-standardized to the Ethiopian 2007 population. Among the 1380 subjects (823 men and 557 women), 68.7% had less than 1 serving of fruits and vegetables per day, 41.0% were physically inactive, and 57.3% observed religious fast. The age-standardised prevalence of abdominal obesity was 29.3% in men and 58.5% in women, but that of metabolic syndrome was comparable between men (39.2%) and women (39.0%). The prevalence of diabetes was underestimated if only fasting blood glucose (FBG) was used for the diagnosis compared to combination of FBG and glycated haemoglobin (HbA1c) (6.7% in men and 3.8% in women vs. 12.1% in men and 5.6% in women). More than a quarter (26.1%) of men and 8.7% of women had estimated 10-year risk of cardiovascular disease of 10% or more. This study revealed the high prevalence of NCD metabolic risk factors among the urban public employees in the highland of Ethiopia.

Acquired but Unvested Welfare Rights: Migration and Entitlement Barriers in Reform-Era China

AbstractScholars studying Chinese development have long acknowledged the significance of the hukou system in impeding internal migration and defining welfare entitlements. However, another crucial barrier is often overlooked: the incomplete transferability of acquired welfare rights. By examining the case of the Urban Employee Basic Pension System, this paper aims to understand how the limited transferability of acquired rights acts as an obstacle to labour migration and entitlement accomplishment. It also seeks to explore the factors that are accountable for the low level of welfare rights transferability. Our findings suggest that migration and entitlement barriers today may not be so much a question of a particular form of hukou exclusion but more of a problem of insufficient rights portability. An in-depth understanding of the structural constraints of China's reform-era migration and rights attainment needs to take into account the transferability of welfare entitlements for migrant workers, and go beyond a narrow conceptualization of the hukou system per se.

Evaluation of day care versus inpatient cataract surgery performed at a Jiangsu public Tertiary A hospital

BackgroundHigh cataract incidence and low cataract surgical rate are serious public health problems in China, despite the fact that efficient day care cataract surgery has been implemented in some public Tertiary A hospitals in China. In this study, we compared not only clinical outcomes, hospitalization time and total costs but also payment manners between day care and inpatient procedures for cataract surgery in a Jiangsu public Tertiary A hospital to put forward several instructional suggestions for the improvement of government medical policies.MethodsIn total, 4151 day care cases and 2509 inpatient cases underwent the same cataract surgery in the day care ward and ordinary ward respectively, and were defined as two groups. General information, complications, postoperative best corrected visual acuity (BCVA), hospitalization time, total costs and especially payment method were analyzed to compare day care versus inpatient.ResultsThe general data display no significant differences (P > 0.05), and no significant difference between complications and postoperative BCVA were observed between the two groups (P > 0.05). The period of stay in hospital was significantly different (P < 0.001). The total costs were lower for day care than for inpatients (P < 0.001). To avoid sampling error, we analyzed the data of payment manner for each patient among this period. Day care patients tended to pay for the procedure using the Urban Employees Basic Medical Insurance (UEBMI) method, while inpatients tended to use the Out-of-Pocket Medical Treatment (OMT) payment method (P < 0.001).ConclusionDay surgery of cataract is more cost-effective and efficient than inpatient surgery with equivalent clinical outcomes. As an efficient therapeutic regimen, day care surgery should be further promoted and supported by the government policies.

The Misunderstanding of Social Insurance: The Inadequacy of the Basic Pension Insurance for Urban Employees (BPIUE) for the Aging Population of China

The Chinese public has shown increasing concern about the “inadequacy” of the funds available for the Basic Pension Insurance for Urban Employees (BPIUE). The government has managed the issue by balancing the program’s revenue and expenditures each year and by increasing subsidies for it from all levels. These actions have raised a number of questions, such as why the program still needs financial subsidies as the fund’s balance continues to increase. The BPIUE was initiated in 1991, and the combination model of “social pooling” and “individual accounts of employees” was established in 1995 and formally launched in 1998. Also, in 1998, reforms including the downsizing of state-owned enterprises were implemented, and tens of millions of employees of state-owned enterprises entered early retirement. Local governments used funds from the individual accounts to pay pensions to employees based on length of service, and as a result, the individual accounts have remained empty ever since. Based on the definition of social insurance and an empirical analysis of the BPIUE fund, this paper conducts a qualitative and quantitative analysis of the plan from two perspectives, striving to provide an objective explanation and assessment of the pension fund’s inadequacy. On this basis, the paper analyzes the impact of the aging population of China on the existing and future BPIUE fund gap.

Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China.

While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.

Study on the equity of medical services utilization for elderly enrolled in different basic social medical insurance systems in an underdeveloped city of Southwest China

BackgroundThe equity of medical services utilization for elderly individuals enrolled in different basic social medical insurance systems holds significant meaning for social harmony against a background of demographic aging and a growing wealth gap in China. This study is to explore the equity of the three medical insurance systems in southwest China with the aim of providing recommendations for relevant policy.MethodsA total of 9600 elderly people insured through basic social medical insurance were selected and interviewed with a questionnaire. This study used a binary logistic regression model to investigate the effect of household income for medical services utilization and adopted a concentration index to measure the inequity of medical services utilization among elderly participants enrolled in different medical insurance categories.ResultsOutpatient services utilization was almost identical in the different insurance systems (78.5%, 77.7% and 78.6%). There were no statistically significant differences according to income level in the Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) programs, but in the New Cooperative Medical Scheme (NCMS), higher-income groups tended to utilize more services. The corresponding concentration index (CI) values were 0.0162, 0.0173 and 0.0179 respectively. The NCMS showed a lower hospitalization rate than UEBMI and URBMI (17.7% vs 24.2% and 24.9%). The higher income group utilized hospitalization more, regardless of the insurance system. The corresponding CI values were 0.0817, 0.0605 and 0.0319 respectively.ConclusionThe equity of medical services utilization for elderly exist in all three health insurance systems, in particular, the inequities in utilization of hospitalization were more severe than outpatient services. UEBMI and URBMI were better than NCMS in the equity of outpatient services. Although NCMS was more equitable than URBMI and UEBMI in terms of hospitalization, this was based on “overall low utilization of hospitalization regardless of income levels” in NCMS compared with URBMI and UEBMI. The disparities of the three basic social medical insurance systems should be eliminated. For low-income residents, specific insurance policies including reducing deductible, covering more medical service and increasing reimbursement ratio could be considered.

PCV73 - Adherence and Persistence with Antiplatelet Agents in Patients with New Episode of Acute Coronary Syndrome in Tianjin, China

To investigate the adherence and persistence with antiplatelet agents and their associated factors among patients with new episode of acute coronary syndrome (ACS) in Tianjin, China. Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011-2015). Adult patients who initiated antiplatelet agents within 30 days after discharge with a hospitalization for ACS (index hospitalization) during 2012.01.01-2014.12.31, and had continuous enrollment during 12-month pre- (baseline) and 12-month post- (follow-up) index hospitalization were included. Patients who had previous evidence of ACS or prescription of antiplatelet agents during baseline period or had major adverse cardiovascular events within the initial 30 days after discharge were excluded. Patients who had a ≥80% proportion of days covered (PDC) were considered adherent, while patients who had no gaps of ≥30 days in antiplatelet therapy were considered persistent. Logistic and Cox models were used to explore the associated factors for adherence and persistence, respectively. 5,486 patients (63.2±10.8 years; 60.2% male) were identified. Only 10.9% (N=600) of them were adherent to antiplatelet agents during follow-up, and the mean PDC was 0.39±0.29 for the total cohort. 90.1% (N=4,942) patients discontinued antiplatelet agents during follow-up and the average time to discontinuation was 103.89±110.27 days. Male, patients who received percutaneous coronary intervention (PCI) or those who had longer stay during index hospitalization had better adherence (Odds ratio [95% CI]=1.88 [1.49-2.37]; OR=3.77 [3.11-4.57]; OR=1.03 [1.01-1.05]) and persistence (Hazard Ratio [95% CI]=0.82 [0.77-0.88]; HR=0.41 [0.39-0.44]; HR=0.99 [0.98-1.00]). Patients with prior use of calcium channel blocker (CCB) (OR=0.73 [0.55-0.97]) had lower adherence, while those with prior use of β-blockers (HR=1.08 [1.00-1.17]) had lower persistence. Adherence and persistence with antiplatelet agents was unsatisfactory among patients with new episode of ACS in Tianjin, China. Male, receiving PCI and longer stay during index hospitalization were associated with better adherence/persistence.

PCV8 - One-Year Clinical Outcomes In Patients With Acute Coronary Syndrome In Tianjin, China

To evaluate the one-year clinical outcomes and identify its associated factors in patients with acute coronary syndromes (ACS) in Tianjin, China. Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011-2015). Adult patients who were discharged alive after the first ACS-related hospitalization (index hospitalization) during 2012.01.01-2014.12.31 and had continuous enrollment during 12-month pre- (baseline) and 12-month post- (follow-up) index hospitalization were included. Clinical outcomes were measured by subsequent major adverse cardiovascular events (MACE) including hospitalization for myocardial infarction (MI) or stroke, all-cause mortality, or their composite endpoint. Cox model was used to explore the factors associated with MACE. 22,041 patients (64.7±10.7 years; 54.4% male) were identified. 9.5% (N=2,099) experienced MACE during follow-up with a mean number of 1.3±0.8. 3.1% (N=680) had MI, 5.7% (N=1,253) had stroke and 1.4% (N=298) had all-cause death. Among patients who experienced MACE, average time from index discharge to the 1st MACE was 143.2±118.8 days, and 42.1% (N=883) experienced MACE within 90 days after discharge. Being older (age 55-64: Hazard Ratio [95% CI]=1.28 [1.06-1.54]; age 65-74: HR=1.57 [1.27-1.92]; age ≥75: HR=1.91 [1.56-2.35], respectively, vs. age ≤54), male (HR=1.47 [1.34-1.61] vs. female) or patients who had higher Charlson Comorbidity Index (CCI) (HR=1.09 [1.05-1.14]) were more likely to experience MACE. Patients who had prior stroke (HR=1.77 [1.59-1.96]) and prior all-cause hospitalization (HR=1.36 [1.22-1.53]) were more likely to experience MACE, whereas prior angina (HR=0.81 [0.72-0.90]), prior β-blockers utilization (HR=0.82 [0.75-0.91]) and received percutaneous coronary intervention (PCI) during index event (HR=0.73 [0.64-0.82]) were less likely to experience MACE. Stroke is the most common type of MACE among ACS patients in Tianjin. Almost half of the 1st MACE occur within the 3 months after ACS. Patients older, male, having higher CCI and with prior stroke are at higher risk of MACE.

PCN42 - Use of Anti-Diabetic Medication is Not Associated with Cancer Risk in Chinese Patients with Type 2 Diabetes

Based on some meta-analyses of observational studies and several RCT, it is not conclusive whether metformin use reduces cancer risk in type 2 diabetes. This study aimd to investigate whether use of anti-diabetic medication including metformin, sulfonylureas, thiazolidinediones, α-glucosidase inhibitors and insulin is associated with the overall and site-specific cancer risk, controlling for potential bias. Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2003-2014). Adult patients who were newly diagnosed with type 2 diabetes in 2009, and only used 1 class of anti-diabetic medication during the 1st year follow-up were included and grouped accordingly. Newly-diagnosed patients who had no prescription of antidiabetic medication during the whole follow-up period were identified as the untreated group. Overall and 5 site-specific (stomach, colorectum, liver, lung, breast) cancer incidence rates were calculated for all 6 groups during follow-up. Multivariate Cox proportional hazards models adjusting for baseline characteristics were further conducted. A total of 3901 diabetic patients were included (648 for untreated, 630 for metformin, 1053 for sulfonylureas, 159 for thiazolidinediones, 613 for α-glucosidase inhibitors, and 798 for insulin). The average ages were between 58.2 to 60.8 years across 6 groups. During the 5-year follow-up period, 161 patients were newly diagnosed with cancer, without significant differences of cancer incidence rates presented across 6 groups. Compared with the untreated group, the hazard ratios of overall cancer risk were 0.68 [95%CI: 0.38-1.23] for metformin, 0.87 [0.54-1.40] for sulfonylureas, 0.59 [0.21-1.70] for thiazolidinediones, 1.09 [0.65-1.83] for α-glucosidase inhibitors and 1.09 [0.66-1.81] for insulin group. Similar to the findings regard to overall cancer risk, no significant differences regard to site-specific cancer risk were detected across 6 groups. No association was found between antidiabetic medication use and cancer risk among patients with newly-diagnosed type 2 diabetes in China.

Equity in patient experiences of primary care in community health centers using primary care assessment tool: a comparison of rural-to-urban migrants and urban locals in Guangdong, China

BackgroundThe equity of rural-to-urban migrants’ health care utilization is already on China’s agenda. The Chinese government has been embarking on efforts to improve the financial and geographical accessibility of health care for migrants by strengthening primary care services and providing universal coverage. Patient experiences are equally vital to migrants’ health care utilization. To our knowledge, no studies have focused on equity in the patient experiences between migrants and locals. Based on a patient survey from Guangdong, China, which has a large number of rural-to-urban migrants, our study assessed the equity in the primary care patient experiences between rural-to-urban migrants and urban locals in the same health insurance context, since different forms of insurance can affect the patient experiences of primary care.MethodsWe stratified our samples by different insurance types into three layers. We assessed primary care patient experiences using a validated Chinese version of the Primary Care Assessment Tool (PCAT), including eight primary care attributes. A ‘PCAT total score’ was calculated. Data were collected through face-to-face and one-on-one surveys in 2014. Propensity score matching (PSM) was used for each layer to generate comparable samples between rural-to-urban migrants and urban locals. Based on the matched dataset, a t-test was employed to compare the primary care patient experiences of the two groups.ResultsUsing PSM, 220 patients in the rural-to-urban migrants group were matched to 220 patients in the urban locals group. After the matching, the observed confounding variables were balanced, and the PCAT scores were almost equal between the two groups. The only slight differences existed in the Urban Employee Basic Medical Insurance layer and in the without basic medical insurance coverage layer.ConclusionsEquity in the primary care patient experiences between rural-to-urban migrants and urban locals seems to have been achieved to some extent. However, there is room for improvement in the equity of coordination of care and comprehensiveness. Policy makers should consider strengthening these two dimensions by integrating the health care system. More attention should be focused on helping migrants break down language and cultural barriers and improving the patient-physician communication process.

Incidence and risk factors of cardiac complications among patients with osteoporotic hip fractures

Objective To estimate the incidence and risk factors of cardiac complications in patients with osteoporotic hip fractures. Methods A retrospective case series study was conducted on the clinical data obtained from 30% of the randomized sample population of Tianjin Urban Employee Basic Medical Insurance database (2009-2014). Patients who had ≥1 diagnoses of hip fracture between 2010 and 2013, aged ≥50 years, and were continuously enrolled from 12 months before (baseline period) to 12 months after (follow-up period) the first osteoporotic hip fracture diagnosis were included in this study. The incidences of cardiac complications were estimated at 3, 6, 9 and 12 months after the fractures, and incidences of cardiac complications which occurred 12 months before and after the fracture were compared. Multiple factors cox proportional hazards regression was used to identify the risk factors of cardiac complications after osteoporotic hip fractures. Results A total of 2 353 osteoporotic hip fracture patients were included [age: (71.4±10.3)years; female: 58.4%]. After hip fracture, the accumulated 12-month incidence of arrhythmia (23.2% vs.9.7%, OR=2.39, 95%CI 2.11 2.72, P<0.01), angina (16.0% vs.7.9%, OR=2.03, 95%CI 1.75 2.35, P<0.01), heart failure (5.9% vs. 2.7%, OR=2.19, 95%CI 1.68 2.85, P<0.01) and myocardial infarction (3.2% vs. 2.0%, OR=1.63, 95%CI 1.19 2.23, P<0.01) were significantly higher than those before fracture, and these complications mostly occurred within 3 months after osteoporotic hip fracture. Patients aged older (OR=1.01, 95%CI 1.00 1.02, P<0.01) with the history of hypertension (OR=1.40, 95%CI 1.14 1.73, P<0.01), coronary heart disease (OR=1.25, 95%CI 1.01 1.53, P<0.05), hyperlipidemia (OR=1.20, 95%CI 1.02 1.42, P<0.05), chronic pulmonary diseases (OR=1.18, 95%CI 1.01 1.38, P<0.05), congestive heart failure (OR=1.70, 95%CI 1.16 2.50, P<0.01), arrhythmia (OR=1.88, 95%CI 1.54 2.29, P<0.01), or renal disease (OR=1.35, 95%CI 1.07 1.69, P<0.05) were at higher risk of cardiac complications. Conclusions The incidence of cardiac complications is significantly increased after osteoporotic hip fractures. Age and disease history at baseline are correlated with the risk factors. Key words: Osteoporositic fractures; Hip fractures; Postoperative complications; Heart diseases; Risk factors