Explore the vast range of titles available.

Background Individuals’ interpretations of health are inherently subjective, influenced by diverse cultural background and upbringing. This study aimed to examine differences in self- reported severity of depression and cognitive symptoms among middle-aged and older adults from China and the United States. Methods With data on middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS), Health and Retirement Study (HRS), and the Disability Vignette Survey (DVS), we conducted estimations utilizing generalized ordered probit models. These models captured respondents’ ratings of each vignette character’s health problem. To account for reporting heterogeneity in depression and cognitive severity, we subsequently applied a hierarchical ordered probit model for adjustment. Results Compared to US respondents, Chinese respondents exhibited lower mean scores in self-rated depression and cognitive severity for both themselves and the vignette characters. Upon adjusting the results for reporting heterogeneity, it became evident that Chinese respondents experienced more pronounced depression (β = 0.202, p  < 0.001) yet displayed better cognitive status (β = -0.239, p  < 0.001) compared to their US counterparts. Notably, the thresholds employed by respondents to assess depression and cognitive status displayed systematic variations between the two countries, often showing non-parallel shifts ( p  < 0.05). Middle-aged and older adults in China maintained lower health assessment standards or expectations when compared to their US counterparts. Additionally, higher levels of education exerted a positive and protective influence on depression and cognitive status for individuals in both China and the United States. It’s important to note that the effects of urban-rural areas and living arrangements varied across these populations. Conclusions Significant disparities were observed in self-rated levels of depression and cognitive severity between middle-aged and older adults in China and the United States. Moreover, these disparities extended to the criteria utilized in their assessments. Addressing mental health interventions and management for this demographic in both countries should be prioritized and bolstered.

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.

Degludec insulin liraglutide injection is the world's first and only approved basal insulin GLP-1RA injection in China (GLP-1RA stands for Glucagon-Like Peptide-1 Receptor Agonist. This study aimed to evaluate the long-term cost-effectiveness of IDegLira versus GLP-1RA added to basal insulin regimen (combined regimen) for patients with type 2 diabetes in China. Based on the perspective of the health system, the study adopts the Swedish Institute for Health Economics diabetes cohort model. The baseline and clinical efficacy data in the model are from the EXTRA study. The cost includes glucose-lowering medication, background treatment cost, and complication treatment costs. The prices of IDegLira and GLP-1RA are based on the national medical insurance payment standards. Insulin adopts the national volume-based procurement average price. Other cost and utility data are sourced from published literature. The health outcome indicator is quality-adjusted life years (QALYs). The simulation time horizon is 30 years. The discounting rate of cost and health outcomes is 5%. In clinical output, IDegLira could reduce the cumulative incidence of various chronic complications in patients compared to the combined regimen. The eye diseases (background, proliferative retinopathy, macular edema, and visual loss) decreased by 24.4%, 41.1%, 18.9%, and 12.2%, respectively. Neuropathy decreased by 17.3%. Proteinuria and end-stage renal disease decreased by 25.9% and 17.6% respectively. Ischemic heart disease, heart failure, and myocardial infarction (stroke) decreased by 0.8%, 1.1%, and 4.7%, respectively. In the base-case analysis, IDegLira compared to the combined regimen shows an incremental cost of -34,254 CNY and an incremental QALYs of 0.436. Under the threshold of 1 times the per capita GDP of China in 2022 (85,698 CNY), IDegLira is a dominant scheme with lower cost and better health outcome. In probabilistic sensitivity analysis, the probability of IDegLira being cost-effective is 100%, indicating that the base-case analysis results are robust. Compared with the combined regimen, the use of IDegLira for Chinese patients with type 2 diabetes can improve long-term health output, save medical costs, and is a dominant scheme.

Background In 2021, IDegLira was introduced in China as a treatment option for patients with type 2 diabetes mellitus (T2DM). We aimed to evaluate the long-term cost-utility of IDegLira compared to basal-bolus therapy and glucagon-like peptide-1 receptor agonist (GLP-1RA) added to basal insulin in patients with T2DM who remain uncontrolled on basal insulin in China. Methods The Swedish Institute for Health Economics (IHE) T2DM Cohort Model was employed to project health and cost outcomes over a 30-year time horizon. Baseline cohort characteristics were derived from the DUAL II China study. Treatment effects were derived from DUAL VII study and a pooled analysis. Costs were considered from a health system perspective in China and expressed in 2023 Chinese yuan (CNY). Health outcomes were measured in quality-adjusted life years (QALYs). Health state utilities were obtained from several published sources. Future costs and clinical outcomes were discounted at an annual rate of 5%. Results IDegLira was associated with an improvement of 0.810 QALYs and a cost reduction of CNY 91,217 compared to basal-bolus therapy. Similarly, compared to GLP-1RA added to basal insulin, IDegLira demonstrated a health gain of 0.011 QALYs and a cost reduction of CNY 23,815, establishing IDegLira as the dominant option. The sensitivity analyses indicated a 100% probability of IDegLira being cost-effective. Conclusions For T2DM patients who remain uncontrolled on basal insulin, IDegLira was projected to be dominant and could offer better value compared to both basal-bolus therapy and GLP-1RA added to basal insulin in the Chinese setting.

Background More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China’s total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China. Methods A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed. Results (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers. Conclusion It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW’s characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW’s job stability.

Background Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China. Methods A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed and bianzhi (formally established post). Results A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed). Conclusion Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.

Objective To compare the cost-effectiveness of tandem mass spectrometry (MS/MS) screening for neonatal inherited metabolic diseases (IMDs) with fluorescence analysis (FA) screening for neonatal inherited metabolic diseases (IMDs) and provide evidence for promoting MS/MS in China. Methods An Excel-based decision tree model was constructed to evaluate the cost-effectiveness of MS/MS versus FA screening from a societal perspective. The model simulated the screening pathway, prevention, and treatment of IMDs, adjusted to 2023 price levels. Health outcomes were measured in quality-adjusted life years (QALYs), with a 3% annual discount rate applied. The willingness-to-pay (WTP) threshold was set at one times the per-capita GDP of China in 2023. Results MS/MS screening was more costly (CNY 1,121,637; USD 158,423 vs. CNY 380,276; USD 53,711) but more effective (16.47 QALYs vs. 5.93 QALYs) than FA screening. The incremental cost-effectiveness ratio (ICER) was CNY 70,286 (USD 9,927) per QALY, below the WTP threshold. The benefit–cost ratio (BCR) was 1:3.94. Conclusion While MS/MS screening incurs higher costs, it achieves significantly greater QALY gains and demonstrates favorable cost-effectiveness and economic benefits. MS/MS screening should be actively promoted for neonatal IMDs in China.

•Dronedarone was a cost-effective AAD compared to amiodarone or sotalol for patients with paroxysmal or persistent AF in China.•The incremental cost associated with dronedarone was effectively offset by cumulative benefits in life expectancy and QALY in the long-term rhythm control.•Cost-effectiveness results highlighting the economic value of adopting dronedarone as an alternative first-line AAD option. Antiarrhythmic drug (AAD) therapies are foundational in the long-term management of atrial fibrillation (AF), yet there remains uncertainty in clinical and reimbursement decisions in China. This study aimed to estimate the cost-effectiveness of dronedarone compare to amiodarone and sotalol for the treatment of paroxysmal or persistent AF in China from the health system perspective. A Markov decision model was developed to compare the lifetime clinical efficacy and costs of three AAD therapies associated with AF recurrence, congestive heart failure, strokes, and deaths due to AF or AF related complications. Model inputs were derived from the ATHENA trial results, real-world database, published literature, and supplemented from expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER), defined as the incremental cost per quality-adjusted life year (QALY) gained among groups. One-way sensitivity, probabilistic sensitivity, and scenario analyses were performed to explore the uncertainty of the model. This study used a simulated cohort with baseline characteristics of patients from the CCC-AF project. In the base case, compared to amiodarone and sotalol, dronedarone was expected to gain additional 1.28 QALYs (5.15 vs 3.87) and 1.78 QALYs (5.15 vs 3.37), with higher costs of $6632 ($11,025 vs $4393) and $6278 ($11,025 vs $4748) over a lifetime horizon, leading to ICERs of $5166 and $3524 per QALY, respectively. One-way sensitivity analysis revealed that the results were most sensitive to the relative risk of cardiovascular mortality, the discount rate of QALYs, and the utility for sinus rhythm. The probabilistic sensitivity analyses indicated that the probability of cost-effectiveness for dronedarone ranged from 97.0% to 99.4% at the threshold of one to three times China’s per capita gross domestic product in 2023, whereas the probability for amiodarone ranged from 3.0% to <1%, and for sotalol was always <1%. Scenario analyses confirmed that the base-case results were sufficiently reliable. Our analysis suggests that dronedarone is a cost-effective AAD compared to amiodarone and sotalol for patients with paroxysmal or persistent AF in China, offering improvements in life expectancy and QALY in the long-term rhythm control.

Background Inherited metabolic disorders (IMDs) are a significant cause of morbidity and death among children. To determine the cost-effectiveness of newborn screening for IMDs using tandem mass spectrometry (MS/MS) compared to the non-screened group in China. Methods We constructed a decision tree screening model based on the Chinese clinical path of tandem MS/MS screening for inherited metabolic disorders (IMDs) from the medical health system. This model simulated the mechanism of screening in the prevention and treatment of IMDs. The IMDs screening data was collected from Children’s Hospital of Shanghai between 2010 and 2021. The Quality-adjusted life years (QALYs) and life expectancy were obtained from literature, while cost data was mainly sourced from hospital records and literature. Results In the base-case analysis, the total lifetime cost per patient was higher for the MS/MS screened group at 1,000,452 Chinese Yuan (CNY) (USD 143,515), compared to 157,303 CNY (USD 22,565) for the non-screened group. The QALYs gained were 16.47 and 3.97 for the screened and non-screened groups, respectively. The incremental cost-effectiveness ratio (ICER) of the MS/MS screened group compared to the non-screened group was 67,417 CNY (USD 9,671) per QALY gained, which is under the threshold of 3 times per capita GDP of China in 2022 (242,928 CNY, USD 34,848). The benefit-cost ratio (BCR) was 4.23, which means that for every 1 CNY (USD 0.1434506) invested, a return of 4.23 CNY (USD 0.57) can be obtained. The probability of cost-effectiveness was 100% in the MS/MS screened group compared to the non-screened group, indicating that the results of the base case analysis were robust. Conclusion Compared to the non-screened group, the MS/MS screened group incurs higher costs but also yields significantly greater QALY gains. Considering both the costs and benefits, the MS/MS screened group is an attractive cost-effective option at the current willingness-to-pay threshold for IMDs screening in China. Key points • Text Text Text. •Research Significance: The study assesses the cost-effectiveness of MS/MS screening for IMDs in Chinese newborns, crucial for resource allocation and policy decisions. •Results Interpretation: MS/MS screening has higher costs but significantly better health outcomes, making it a cost-effective option below the GDP threshold. •Innovativeness: The study introduces a rigorous cost-effectiveness analysis to evaluate different screening strategies for IMDs. •Implications for Screening: The findings guide policymakers and healthcare providers towards a more effective and efficient newborn screening program for IMDs in China.

Purpose Patients with advanced non-small cell lung cancer (NSCLC) mostly receive essential routine care and support from informal caregivers, who usually experience poorer health-related quality of life (HRQoL). The study aimed to evaluate the HRQoL and its predictors among informal caregivers of patients with advanced NSCLC in China. Methods We interviewed the adult caregiver population of patients with advanced NSCLC (stage IIIB~IV) in nine tertiary hospitals from multiple provinces in China between November 2020 and June 2021. The EQ-5D-5L instrument measured the HRQoL of caregivers, as analyzed by employing descriptive analysis, univariate analysis, Tobit regression, and multivariate logistic regression, and investigated the important influencing factors further. Results A valid sample of 553 caregivers was analyzed. The mean EQ-5D-5L utility score of caregivers was 0.92 (SD = 0.14). Caregivers reported the greatest problems in mental health, with 45.39% reporting slight, moderate, severe, or extreme anxiety/depression. The potential influencing factors of HRQoL in caregivers included patients' age and cancer histology, relationship with the patients, and daily caregiving hours. Compared to other caregivers, patients' spouses had the lowest HRQoL. In addition, over six hours of caregiving per day was associated with lower HRQoL in caregivers of patients with advanced NSCLC. Conclusions The HRQoL of caregivers for patients with advanced NSCLC was investigated for the first time in China. The informal caregivers experience decreased HRQoL, with anxiety /depression problems being reported the most. The findings of this study would provide extensive information on the HRQoL of advanced NSCLC patients' caregivers for future health-promoting self-care.