Wuhan Research Articles

Research on the Evaluation of an Age-Friendly Layout of Medical Service Facilities in Wuhan City Based on Accessibility

Accessibility is an important indicator for measuring the level of medical facility services in cities. Traditional studies on healthcare accessibility for the elderly have typically focused on the capabilities of emergency services while overlooking the daily independent healthcare needs of the elderly. Taking Wuhan City as an example, the Gaussian two-step floating catchment area method is used in this study to measure the accessibility of urban elderly residents with respect to general hospitals, specialized hospitals, and community health service centers. It also analyzes the appropriateness of the medical facility layout for the elderly in Wuhan City. The research findings indicate the following: (1) The accessibility evaluation method for urban medical facilities established with the Gaussian two-step floating catchment area model can accurately assess the supply–demand relationship between the elderly and various levels of medical facilities. (2) The overall coverage of medical service facilities in Wuhan City is relatively high, but there are significant differences in accessibility for elderly residents in different areas. (3) The appropriateness of daily healthcare access for elderly residents in the central urban areas of Wuhan City is mainly influenced by the layout of general hospitals, while, in the peripheral areas, it is mainly influenced by the layout of specialized hospitals and community health service centers. (4) Improving the appropriateness of urban medical facilities for elderly individuals requires differentiated improvement measures tailored to the characteristics of different zones.

The association of organochlorine pesticides and polychlorinated biphenyls exposure with dyslipidemia and blood lipids: The mediating effect of white blood cell counts

Epidemiological evidence regarding the associations of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) with lipid metabolism and its potential biological mechanisms remain largely unknown. We intended to explore the associations of OCPs and PCBs with dyslipidemia and blood lipid levels, and further evaluate the mediating role of total and differential white blood cell (WBC) counts. We measured the blood lipid levels, the concentration of OCPs/PCBs and WBC counts in serum among 2036 adults in Wuhan city, China. In the multiple-pollutant models, the results showed that β-hexachlorocyclohexane (HCH), p,p′-dichlorodiphenyldichloroethylene (DDE), and PCB-153 were positively correlated with increased odds of dyslipidemia. p,p′-DDE and PCB-153 were correlated with elevated triglyceride (TG) and lowered high-density lipoprotein cholesterol (HDL-c). A positive relationship was observed between p,p′-DDE and total cholesterol (TC) as well. Meanwhile, weighted quantile sum (WQS) regression analyses revealed that PCB and OCP mixtures were positively related to dyslipidemia risk and TG and negatively associated with HDL-c, to which p,p′-DDE was the major contributor. BMI, gender and age might modify the associations of OCPs and PCBs with dyslipidemia and TG. Furthermore, we found that WBC counts were significantly associated with dyslipidemia and blood lipid levels, and a positive correlation was also found between p,p′-DDE and lymphocyte count. Mediation analysis further indicated that lymphocyte count might mediate the associations of p,p′-DDE with dyslipidemia, TG, and TC. Accordingly, our results showed that OCPs and PCBs were related to abnormal lipid metabolism, which was partially mediated by WBC counts.

A cross-sectional survey on the effects of the COVID-19 pandemic on psychological well-being and quality of life in people with spinal cord injury

BackgroundSARS-CoV-2 (COVID-19) has disrupted lives worldwide, affecting individuals from all walks of life. Individuals who have a spinal cord injury (SCI) are also affected by this phenomenon. This survey compares the quality of life (QOL), depression, and anxiety of SCI patients before and during COVID-19 in Wuhan City, China.MethodsA cross-sectional survey utilized an online questionnaire to assess the QOL, levels of anxiety, and depression among 189 SCI patients admitted to Wuhan Tongji Hospital during pandemic from November 2020 to April 2021. Data before COVID-19 outbreak from November to December 2019 was retrieved from hospital records with the same assessment previously performed in-person or during a follow up visit. However, some participants were excluded for various reasons, such as declining to participate, not being admitted to a rehabilitation program due to the pandemic, or being under 18 years old. The World Health Organization’s (WHO) QOL-Brief Version (BREF) and disability (DIS) modules, which focus on disability-related QOL, were used to assess the participants’ QOL.ResultsSCI patients had lower QOL scores during the pandemic compared to pre-pandemic times. Mean scores on the 12-item DIS module significantly differed before and during the COVID-19 period. Participants showed higher adherence to self-isolation and quarantine measures for high-risk encounters (64.94%), but lower compliance with home disinfection and proper rest practices (23.38%).ConclusionsThe COVID-19 pandemic has had a detrimental effect on the QOL of SCI patients in China, highlighting the urgent requirement for telehealth-based rehabilitation to mitigate its impact. It is crucial to provide essential.

Influence of public health emergency on city image: the case of COVID-19 stigma on Wuhan city

This study explored the influence of COVID-19 stigma on the city image of Wuhan by adopting the associative group analysis method. The collected data were free associations of the word “Wuhan” from 39 non-Chinese participants residing outside of China. It found that there were 12 meaning categories related to the city image of Wuhan, half of which were related to COVID-19, and the other half were related to Wuhan city. 56.45% of the associated words were related to COVID-19 and 43.55% to Wuhan city. The results demonstrated that the city image of Wuhan was impacted by the COVID-19 pandemic, mediated by personal experience and perceived media reports. The associated words have constructed a “Wuhan-COVID-19” stereotype, including “Wuhan-birthplace of COVID” and “Wuhan-eating wild animals”. This reflected that the city image of Wuhan endured stigma in the global community. The study provided implications for eliminating stigma and reconstructing group relationships in the global community.

Comparative Assessment of the Impact of COVID-19 Lockdown on Air Quality: A Multinational Study of SARS-CoV-2 Hotspots.

In response to the global COVID-19 pandemic, nations implemented lockdown measures to contain the virus. This study assessed air pollution levels during and after lockdowns, focusing on the following heavily affected locations: Oulu and Helsinki in Finland, Paris in France, Madrid in Spain, Milan in Italy, and Wuhan in China. Air Quality Index (AQI) data from these locations over two years were analyzed to understand the effects of lockdowns. The study compared COVID-19 lockdowns in these six cities with SARS-CoV-2 measurements using statistical methods. Variations in outdoor pollutants were evaluated through tests, revealing significant differences. Parametric analyses and regression were employed to study the impacts of lockdown measures on pollution and their relationships. The study comprehensively analyzed the effects of COVID-19 lockdowns on air quality, identifying differences, quantifying changes, and exploring patterns in each city. Pollutant correlations varied among cities during the lockdowns. Regression analysis highlighted the impact of independent variables on pollutants. Decreases in NO2 were observed in Helsinki, Madrid, Oulu, Paris, and Milan, reflecting reduced traffic and industrial activities. Reductions in PM2.5 and PM10 were noted in these cities and in Wuhan, except for O3 levels, which increased. The reduction in human activities improved air quality, particularly for NO2 and PM10. Regional variations underscore the need for tailored interventions. The study observed a substantial decrease in both PM2.5 and NO2 levels during the COVID-19 lockdowns, indicating a direct correlation between reduced human activities, such as transportation and industrial operations, and improved air quality. This underscores the potential impact of environmental measures and suggests the need for sustainable practices to mitigate urban pollution.

A Critical Assessment of Remdesivir

Abstract: The COVID-19 pandemic that originated in Wuhan city, China, has affected every village in India. This has killed millions of people. This disease involves symptomatic and asymptomatic mutations. The purpose of this review was to assess the effectiveness of remdesivir particularly against SAR-CoV-2 (Coronaviridae family). The relevant works have been studied with respect to the drug's chemistry, mechanism of action, pharmacokinetics, pharmacodynamics, clinical data, and side effects. Remdesivir has been used in many cases of coronavirus-infected patients because it has been proven to possess beneficial effects; however, significant adverse effects have also been reported. Remdesivir has been reported to help in lowering the disease's high fatality rate. However, the WHO has warned against using the medicine because there is no clinical data to support its therapeutic efficacy.

The barriers on the walkways’ formation for wheelchair users in Wuhan city

The barriers on the walkways’ formation for wheelchair users in Wuhan city

Components of dissolved organic carbon in relation to environmental factors in lakes along an altitudinal gradient in central China.

Dissolved organic carbon (DOC) is an important organic substance that affects biogeochemical processes and underwater light conditions in aquatic ecosystems. To explore altitudinal variations in DOC components and water quality, 66 surface water samples were collected along an altitudinal gradient (10-1857m) in three regions of central China, including a montane region (Enshi Prefecture) and two floodplain regions (Dongting Lake Basin and Wuhan City). DOC components were measured using a three-dimensional excitation-emission matrix (3D-EEM) fluorescence spectroscopy, in conjunction with fluorescence regional integration (FRI) and fluorescence indices. Generally, lakes at high elevations (Enshi Prefecture) had higher DOC concentrations (a mean value of 6.43mgL-1) than floodplain lakes in Dongting Basin (4.51mgL-1) and Wuhan City (3.89mgL-1). Fluorescence index (FI, a range of 1.37-1.92) and biological index (BIX, a range of 0.47-0.74) indicated that DOC mainly originated from allochthonous sources in the three regions. Enshi Prefecture had relatively lower FI and BIX values, suggestive of a larger contribution of allochthonous carbon in this montane region in comparison with the floodplain regions. Humic-like substances were more abundant than other four fluorescent components, including tyrosine-like, tryptophan-like, fulvic acid-like, microbial-like substances. Spearman rank correlation analyses showed that tryptophane-like substances were positively correlated with K+, Mg2+, and Na+, while humic-like substances were negatively correlated with these cations. Taken together, the results can improve our understanding on altitudinal variations in DOC components and potential driving forces.

Research on Construction Method of Water Body Database in Wuhan City

Water is the source of life, the factor of production and the basis of ecology. When controlling flood disasters and planning water use, it is necessary to use the local water body information, so how to grasp the local water body information accurately and real-time becomes crucial. With the development of modern science and technology, image information can be quickly obtained by remote sensing satellites, and corresponding water system information can be obtained by processing satellite image data, and water body database can be established. This paper takes Wuhan city as the research object, uses Landsat-8 satellite images in 2020 as the data source, adopts the normalized differential water index method (NDWI) to extract water system information, and then constructs the database of the obtained water system information of Wuhan City through ArcGIS software, which can provide basic information for water data management of Wuhan City.

Assessing Urban Neighbourhood Resilience to Covid 19 Pandemic in Jos, Plateau State, Nigeria

The sudden incidence of COVID-19 at Wuhan in China in December 2019 with its significant death globally and other negative socio-economic impacts has awakened the need to make human settlements resilient to unforeseen tragedy. Nigeria and Jos the capital of Plateau State have had negative experiences with the incidence of covid 19. Considering this, the study aims at assessing the resilience of urban neighbourhoods in Jos North Local Government Area of Plateau State to COVID-19 pandemic. The study objective is to examine the pattern and characteristics of some selected neighborhoods within Jos the study area. In addition to examining the characterisation of infrastructural facilities and to evaluate the environmental challenges that impede adherence to non-pharmaceutical protocols to COVID-19. Two neighbourhoods, Angwan Rukuba and Fudawa were selected to represent the entire Jos North Local Government Area. Relevant literature related to the study was reviewed. The study adopted a direct observation method of the physical characteristics of the neighborhoods and a simple sampling technique of survey where a structured questionnaire was administered to 138 respondents in the two neighborhoods. Descriptive analysis using percentages and tables in relation to the data obtained was used to draw inferences and conclusions. The results obtained shows that the sampled neighborhoods are densely congested informal settlements with unorganized settlement pattern, lacking in basic neighbourhoods’ infrastructure, and poor circulation, among others. These findings imply that the environmental setting of the study area makes compliance with non-pharmaceutical protocols during COVID-19. pandemic difficult. By implication, the neighborhoods lack the resilience capability to cope with the COVID-19. pandemic. The study recommends the need for planning and upgrading of the neighbourhoods’ facilities along with stakeholder public enlightenment on the need to comply to COVID-19. non-pharmaceutical protocols as a step toward building resilient neighbourhoods in Jos North Local Government Area and the metropolis at large.

Duration of exposure to compound daytime-nighttime high temperatures and changes in population exposure in China under global warming

Global warming has led to the enhancement of diurnal (daytime-nighttime) compound heat waves, which can severely affect the population’s physical health and productive life; this is particularly the case for vulnerable populations that are more susceptible to psychological and physiological harm with the future normalization of heatwave scenarios. In this study, we attributed the changes in population exposure under diurnal compound high temperatures (HTs) and extremely high temperatures (EHTs) to the influence of climatic (exposure duration) and population factors and their combined influence to determine the relationship between exposure duration and the changes in exposure of vulnerable populations. Diurnal compound HT and EHT covered a land area of 4,016,800 and 1,984,200 km2, respectively. The heat-exposed area spread step-like in all directions, centering on the 24-h high-exposure area with a strong gradient effect. The area of prolonged exposure shifted from the Yellow-Huai-Huai Plain across the geographical boundary between the south and the north to the middle and lower reaches of the Yangtze River Plain. Meanwhile, the average maximum value of vulnerable population exposure reached 186,800 and 93,100 person-h, with high values in Zhengzhou, Chongqing, Wuhan, Chengdu, Beijing, and other cities. Changes in vulnerable population exposure were dominated first by demographic factors and then by climatic factors, with the dominance of climatic factors evident in areas of prolonged exposure. Under prolonged exposure to daytime-nighttime compound EHT, changes in the exposure of child and older populations were dominated by climatic factors with a contribution rate of 87.16% and 87.43%, respectively. Therefore, suitable cooling measures should be proposed for vulnerable populations under prolonged exposure, focusing more on the physical and mental health of children and older adults exposed to compound EHT.

Does bike-sharing reduce traffic congestion? Evidence from three mega-cities in China.

This study employs a regression discontinuity design to systematically examine the governance effect of bike-sharing on urban traffic congestion, utilizing city-level data from Beijing, Shanghai, and Wuhan in China between 2016 and 2018. We discover that the introduction of bike-sharing services significantly mitigates traffic congestion in the short term. Our heterogeneity analysis reveals that the initial deployment of shared bicycles primarily alleviates urban congestion, while additional deployments have a limited impact. Further, mechanism test analysis demonstrates that bike-sharing leads to increased metro ridership in these cities, effectively explaining the reduction in road congestion. This study underscores the pivotal role of bike-sharing services in easing urban traffic congestion and provides vital policy insights for enhancing traffic management strategies in Chinese cities.

Meteorological effects of ventilation corridor in central urban areas: A case study of Wuhan

How ventilation corridors affect urban climate is attracting researchers' attention. Taking the inland Chinese city of Wuhan as an example, this paper first uses remote sensing image technology to evaluate the urban thermal environment. Additionally, based on the GIS/RS spatial analysis method, the ventilation corridors in the central urban area are identified and constructed. Finally, the mesoscale meteorological model WRF-UCM is used to simulate four cases with different corridor forms to explore the impact of different corridors on the climate environment in Wuhan during the summer. The results indicate that: (1) The WRF-UCM model, when coupled with LCZ classification, can significantly improve the accuracy of mesoscale urban canopy meteorological field simulations. (2) The water corridors located in the central urban area can effectively regulate the temperature and wind environment during summer. In the high-temperature period of the day, the average temperature in the central city decreases by 0.3–0.4 °C, the heat island proportion index decreases by 1.61 %, and the strong heat island proportion index decreases by 1.89 % in the afternoon. During the period of low temperature, the average wind speed in the central urban area increased by 0.05 m/s increase, and even increased by 0.1 m/s. (3) The specific humidity value of the green corridor is reduced by 0.0000136 kg/kg in comparison to the construction land in the corridor, while the water corridor can increase by 0.000133 kg/kg. If the two kinds of surface, water and green land, are organically combined in the corridor, it will be able to improve the hot and humid conditions in Wuhan in summer. (4)Low-rise and low-density construction land as the corridors in the central urban area can not improve the urban thermal and wind environment. Through an attempt to conduct a complete workflow of urban heat island analysis, ventilation corridor identification and setting, urban climate simulation, analysis and summary, the authors believe that it is an effective set of working methods in sustainable urban planning, design, and policy-making. The implementation of pertinent research findings in the domain of urban planning and design demonstrates its universal applicability and has the potential to extend to analogous research and practice.

Vertical structure and transport characteristic of aerosol and O3 during the emergency control period in Wuhan, China, using vehicle-lidar observations

During the Lunar New Year of 2020, the Chinese government implemented a strict nationwide lockdown to prevent the spread of the COVID-19, which may have led to changes in the distribution of pollutants. To enhance our understanding of the three-dimensional evolution of pollutants under special control scenarios, this study used vehicle lidar to obtain vertical profiles of aerosols and ozone (O3) in Wuhan during the pandemic. Combined with ground observations and WRF-Chem model simulation results, we explored the evolution characteristics of pollutants. The results showed that the fine particulate matter (PM2.5) concentration near the ground in Wuhan City was significantly reduced (40%) during the emission control period. The aerosol concentration decreased rapidly with an increase in height, and the maximum loading height was consistent with the atmospheric boundary layer height. Conversely, due to factors such as the reduction of the precursor nitrogen dioxide (NO2) and rising temperatures, the near-ground O3 concentration increased by 59%. Despite the significant reduction in emission sources, lidar observations still captured distinct aerosol transport layers on March 7 and March 10, 2020. These transport layers gradually descended, affecting the ground-level aerosol concentration. Additionally, one typical process of O3 external transport was observed in the vertical direction. Our study provides a theoretical basis for a deeper understanding of the spatiotemporal distribution characteristics of pollutants during special control scenarios, aiding policymakers in formulating effective air pollution control strategies.

How does urban form explain water cooling effect heterogeneity: A case study in Wuhan, China

Water bodies in urban areas are considered to be natural and effective cooling factors that can help mitigate the urban heat island (UHI) effect. Previous studies highlighted the cooling effect is determined by the size and landscape of the water bodies. However, it is unclear how the urban form surrounding water bodies influences the water cooling effect received by human activity space. Using high resolution data and a multiple linear regression model, the effect of various 2D/3D urban form factors on the average water cooling intensity (AWCI) and water cooling intensity (WCI) at the fine scale were examined in Wuhan City on hot days. We further verified the spatial heterogeneity of the relationship between urban form factors and WCI according to the distance to and size of adjacent water bodies. The AWCI of the entire surrounding area were correlated with building morphology indicators. Urban form indicators effectively explained the variations of WCI at the fine scale, indicating that a mixture of large building volume density (BVD) with small building density (BD), and an aggregated impervious surface area (ISA) with a complex shape were conducive to WCI. Additionally, building morphology had a larger impact on the cooling effect around small water bodies and in the outer buffer area of water bodies. In comparison, the cooling effect of the area surrounding large water bodies was more affected by the landscape of the ISA. We therefore propose a differentiated urban planning strategy to take full use of the limited water cooling effect.

Automated external defibrillator location selection considering myocardial infarction risk and medical resources

AbstractThe effective deployment of medical emergency equipment, such as automated external defibrillator (AED), is essential to myocardial infarction (MI) patients. However, there are shortcomings in current studies that simultaneously consider the risk of MI and the availability of medical resources when siting the AEDs. In this study, an AED site recommendation framework was proposed to address the lack of consideration for both the MI risk and medical resources when siting the AEDs. It conducts the AED sitting under different scenarios considering the spatial distribution of MI risk and healthcare accessibility in Chinese cities. First, an automated machine learning framework data is proposed to estimate the MI risk at the community scale based on multi‐source spatio‐temporal. Second, the accessibility of medical resources was calculated by an improved Gaussian two‐step moving search algorithm. Finally, the AED siting in multiple scenarios is conducted based on the coverage model. The performance of the AED siting model was evaluated at Wuhan city. The results show that MI risk is impacted by both socioeconomic and cultural characteristics (municipal utilities, streetscape environment, educational and commercial facilities). There is a strong spatial heterogeneity in the distribution of both MI risk and medical resources in Wuhan, and an unreasonable match between the two was detected in some regions. Medical resources need to be strengthened in some high‐risk areas, such as rural areas and tourist attractions. In addition, 1015 AED candidate sites were identified by the location set covering problem model, with a 15‐min accessibility rate of 96.5%. Given the limited resources, mobile AEDs which have about 15‐min service range can be deployed based on the maximum covering location problem model to meet the demand in central urban areas efficiently. This study can contribute to more rational selection of AED sites and the prevention of myocardial infarction among residents, particularly when supported by policies that promote balanced regional development of pre‐hospital medical emergency networks.

Guardian of society: Civil society in Nigeria's response to COVID-19 pandemic.

The rapid breakout and dissemination of the coronavirus disease 2019 (COVID-19) infection from the city of Wuhan, China, to the rest of the countries of the world in December 2019 triggered a situation that led the World Health Organization to report it as a global public health emergency. The pandemic resulted in abrupt and significant loss of lives, disruption of economies, loss of livelihoods, and severe hardship across the nations of the world. Nigeria encountered the COVID-19 reality following the discovery of the first case of the infection in the country on February 27, 2020, prompting the government to swing into action to contain its spread. However, the government's response to the pandemic benefited from the support of nonstate actors from the profit and nonprofit sectors. This study, thus, specifically examined the role of civil society organizations (CSOs) in Nigeria's response to the coronavirus crisis. Using data obtained through secondary sources and analysis of thematic and descriptive-interpretive methods, the study found that CSOs impressively contributed to the government's fight against COVID-19, particularly in view of their roles in creating awareness about the virus and rebutting disinformation regarding the disease, among others. Yet, CSOs encountered some problems while undertaking these roles, prominently the closure of the civic space, noninclusion of CSOs in government's pandemic response architecture, and loss of funding. The study recommends, among other things, that in the case of any future public health emergencies of COVID-19 magnitude, the Nigerian Government should make CSOs an integral part of its response structure, while concluding that the application of these measures would incentivize better contributions from CSOs.

Association of ACE2 and TMPRSS2 towards COVID-19 susceptibility

Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) is pneumonia like viral disease which was originated from Wuhan China in 2019. Besides its high morbidity and mortality, a lot of physiological, enzymatic, hormonal and genetic imbalances had also been observed among Corona Virus Disease-19 (COVID-19) patients. The purpose of the present study was the assessment of comorbidities and association of single nucleotide polymorphisms (SNPs) in Angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine (TMPRSS) gene among COVID-19 patients. A total of 300 (healthy control n = 150 COVID-19 n = 150) individuals were sampled and genotyped for ACE2 rs2285666 and TMPRSS rs2070788 SNPs respectively. A total of 92/150 (61.3%) were male infected population, among the various age groups (age group 1: 1–15 yrs; age group 2: 16–30 yrs; age group 3: 31–45; age group 4: 46 and above) where most of the patients were from age group 4 (46 and above) 79/150 (52.7%) followed by age group 3 (31–45) 44/150 (29.3%). Logistic regression analysis showed that among clinical features cough (90%) was observed to be highest followed by fever (80%), sore throat (76%) and shortness of breath (75%). Hypertension (51%), type II diabetes (48.4%), ischemic heart disease (43.3%) history was found to prevalent highly associated with infected individuals. For ACE2 rs2285666, we found disease risk association for both allele and genotype while TMPRSS did not reveal genotype association. It is concluded from the current study that COVID-19 infects majority of male population. ACE2 rs2285666 allele and genotype association was observed with COVID-19 infection and protective association of TMPRSS2 rs2070788 allele towards COVID-19 infection.

A new multi-objective hyperparameter optimization algorithm for COVID-19 detection from x-ray images

The coronavirus occurred in Wuhan (China) first and it was declared a global pandemic. To detect coronavirus X-ray images can be used. Convolutional neural networks (CNNs) are used commonly to detect illness from images. There can be lots of different alternative deep CNN models or architectures. To find the best architecture, hyper-parameter optimization can be used. In this study, the problem is modeled as a multi-objective optimization (MOO) problem. Objective functions are multi-class cross entropy, error ratio, and complexity of the CNN network. For the best solutions to the objective functions, multi-objective hyper-parameter optimization is made by NSGA-III, NSGA-II, R-NSGA-II, SMS-EMOA, MOEA/D, and proposed Swarm Genetic Algorithms (SGA). SGA is a swarm-based algorithm with a cross-over process. All six algorithms are run and give Pareto optimal solution sets. When the figures obtained from the algorithms are analyzed and algorithm hypervolume values are compared, SGA outperforms the NSGA-III, NSGA-II, R-NSGA-II, SMS-EMOA, and MOEA/D algorithms. It can be concluded that SGA is better than others for multi-objective hyper-parameter optimization algorithms for COVID-19 detection from X-ray images. Also, a sensitivity analysis has been made to understand the effect of the number of the parameters of CNN on model success.

The care cascade of chronic obstructive pulmonary disease in China: a cross-sectional study of individual-level data at enrolment into the national ‘Happy Breathing’ Programme

Understanding the chronic obstructive pulmonary disease (COPD) care cascade is crucial for identifying where and when to intervene to improve COPD outcomes. We aimed to determine the proportion of patients with COPD seeking care in China's health system who are lost at each stage of the COPD care cascade and how the patterns of loss vary across geographical regions and population groups. From November 3, 2018, to April 22, 2021, we used individual-level patient data from the national Chinese 'Happy Breathing' Programme, which aims to identify patients with COPD and provide appropriate care. COPD was defined as a post-bronchodilator ratio of forced expiratory volume in 1s to forced vital capacity (FEV1/FVC)<0.70. We calculated the proportions of individuals who, at enrolment into the 'Happy Breathing' Programme, (i) had ever undergone a pulmonary function test, (ii) had been diagnosed with COPD in the past, (iii) were currently on treatment for COPD, and (iv) had achieved control of their COPD. We examined the association between reaching each stage of the care cascade and individual patient characteristics as well as regional-level economic development and available resources in the health system using multilevel regression. Among the 29,201 patients with COPD in the 'Happy Breathing' Programme, 41.0% (95% confidence interval [CI]: 40.4-41.6%) had ever been tested for COPD, 17.6% (95% CI: 17.1-18.0%) had previously been diagnosed with COPD, 8.5% (95% CI: 8.2-8.8%) were currently on treatment for COPD, 4.6% (95% CI: 4.3-4.8%) of patients had mild or no exacerbations in the prior year, and 3.9% (95% CI: 3.7-4.2%) of patients had suffered no exacerbations in the prior year. On average, patients living in the cities of Beijing, Wuhan, and Yinchuan had progressed further along the COPD care cascade than patients living in Daqing and Luoyang. Using multilevel regression, we found that young age, rural residence, and low regional per-capita GDP were significantly associated with larger losses at each stage of the COPD care cascade. Substantial proportions of patients with COPD are lost at each stage of the COPD care cascade in the Chinese health system. The largest losses occur during the initial stages of the cascade, when diagnosis first occurs. New policies and interventions are required to boost COPD care, especially screening and diagnosis, in the Chinese health system to reduce this large disease burden. This work was supported by Major Programme of National Natural Science Foundation of China (82090011), CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-049), and Horizon Europe (HORIZON-MSCA-2021-SE-01; project number 101086139-PoPMeD-SuSDeV). TB was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt professorship award.