INTRODUCTION:Despite the basic medical insurance system achieving 95% coverage in China, platform workers in new forms of employment (PWNFEs) face significant challenges in maintaining continuous participation in basic medical insurance (CPBMI). This study aims to identify distinct patterns of CPBMI by occupational characteristics (CPBMI-OC) and their associated factors. METHODS:We conducted a cross-sectional survey with 641 PWNFEs in China using a structured questionnaire and employed latent class analysis (LCA) to identify patterns of CPBMI-OC. We utilized multinomial logistic regression to examine the associations between patterns of CPBMI-OC and variables, including demographics, socioeconomic status, medical service utilization, and health and insurance statuses. RESULTS:Among the 641 PWNFEs surveyed (74.4% aged 20-39 years, 79.4% male), the basic medical insurance (BMI) coverage rate was 38.7%, with 85.6% of participants reporting interruptions. LCA identified three distinct patterns: (1) fully interrupted, high-income, family migration class (13.4%); (2) high interruption, mid-income, stable residence class (30.9%); and (3) high continuity, low-income, non-contracted individual mobility class (50.7%). Urban and Rural Resident Basic Medical Insurance and urban hukou were positively associated with higher CPBMI probability. In contrast, higher education, better self-rated health, female gender, supplementary insurance coverage, and platform-insurance enrollment linkage were associated with a higher interrupt probability of CPBMI. CONCLUSION:This study highlights the low CPBMI rate. The diverse patterns of CPBMI-OC among PWNFEs underscore the systemic challenges associated with flexible BMI enrollment options, which hinder continuous insurance participation. Our findings emphasize the need for targeted policy interventions to address structural inequities, improve the inclusiveness of BMI schemes, and better accommodate the diverse needs of PWNFEs.

Patients with severe mental disorders in China face a heavy financial burden and are in dire need of government support to help with medical costs. This study aims to study the participation preferences of patients for these policies, and provide a basis for the next path of policies improvement. In this study, a multistage stratified sampling method was used to investigate patients in three communities in Beijing. Based on a literature review and expert consultation, we identified four attributes-Starting payment line, Reimbursement rate, Drug catalogue, and Designated institutions-each with four levels. The choice sets for the discrete choice experiment were determined through an orthogonal design.Conditional logit regression and mixed logit regression models have been constructed based on the choice preference data, while relative importance and scenario prediction analysis have been adopted to measure the emphasis level of policy attributes in patients' minds. All four policy attributes affect patients' preferences for policy participation, while the attributes in descending order of relative importance are starting payment line (29.10%), reimbursement rate (25.40%), drug catalogue(24.19%), and designated medical institutions(21.31%).Patients significantly preferred the policy option with no starting payment line (p<0.01). There are also differences in the attributes that patients with different demographic characteristics consider critical when making choices. We found that patients with lower education levels, those who are employed or retired, and older patients place a higher value on the reimbursement rate. Unemployed patients prioritize the drug catalogue. Younger female patients tend to be more concerned with the starting payment line level compared to older male patients, and unmarried patients also show a preference for the starting payment line. This study has measured demand-side preferences for policy participation from the patient's perspective. This is significant that patients significantly preferred the policy option with no starting payment line and setting community health service centers as designated medical institutions.

Purpose: The coexistence of multimorbidity and frailty is more likely to increase the risk of physical limitations, mortality and other adverse health outcomes in older adults than their individual occurrence. However, whether and how this coexistence is associated with catastrophic health expenditure (CHE) has not been well assessed. This study aimed to evaluate the independent and coexisting effects of frailty and multimorbidity on CHE.Participants and Methods: A total of 4838 participants obtained from the China Health and Retirement Longitudinal Study (CHARLS) without CHE at baseline (2011) were included in the analytical sample. Marginal structural model (MSM) and timevarying Cox regression model were used to assess the independent and co-occurring impact of frailty and multimorbidity on CHE, respectively. Results: Suffering from single chronic disease (HR, 1.26; 95% CI, 1.13-1.40; P < 0.001), multimorbidity (HR, 1.80; 95% CI, 1.63- 1.99; P < 0.001) and frailty (HR, 1.32; 95% CI, 1.21-1.45; P < 0.001) were associated with a higher risk of CHE. Frailty co-occurring with a single chronic disease (HR, 1.28; 95% CI, 1.03-1.60; P = 0.027) or multimorbidity (HR, 1.91; 95% CI, 1.56-2.32; P < 0.001), and multimorbidity co-occurring with frailty also increased CHE risk (HR, 1.32; 95% CI, 1.17-1.48; P < 0.001) compared with single frailty or multimorbidity status.Conclusion: Preventing, postponing, or reducing frailty, and enhancing standard management of chronic diseases are essential in reducing healthcare costs and preventing families from poverty. More efficient interventions for frailty and multimorbidity are urgently required.

Mental health problems have become a major public health problem worldwide and are more common among middle-aged and elderly people in China. Research on the effect of education on depression is limited, and whether the relationship between education and depression changes over the life course remains unclear. This study was based on the cross-sectional data of 15,767 middle-aged and elderly individuals in the 2018 tracking survey (Wave 4) of the China Health and Retirement Longitudinal Study (CHARLS) database. Multiple linear regression and bootstrap methods were developed to detect the mediating effect of education on depression. In all samples or different age groups, education was significantly positively associated with depression. Three mediators (economic level, health-related lifestyle, and cognitive level) were significantly positively associated with depression, and cognitive level had a greater effect on depression than economic level and health-related lifestyle. The total, direct, and indirect effects of the whole samples and elderly samples were significant; however, the direct effect of the middle-aged samples was insignificant, and the total and indirect effects of the three mediating pathways were all significant, that is, economic level, health-related lifestyle, and cognitive level should produce complete mediation. The multiple linear regression and bootstrap methods could successfully detect the mediating effect of education on depression. On the basis of the education, economic level, health-related lifestyle, cognitive level, and depression of middle-aged and elderly people, we established and compared the total, direct, and mediating effects of education on depression under the life course. The mediating variables should be further increased, and the measurement methods of depression should be developed to improve the credibility of the research results.

Objective This study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department. Methods Medical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness. Results Nearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462–5.435]; P < 0.001) were more likely to go from “inappropriate” to “appropriate” than younger counterparts. Compared with circulatory diseases, the case evaluated as “appropriate” at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019–2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737–5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268–0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355–0.873]; P = 0.011). Conclusions Many disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases.

BACKGROUND:Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults.OBJECTIVE:This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors.METHODS:A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects.RESULTS:Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition.CONCLUSIONS:Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.

Abstract Purpose Patients with severe mental disorders in China face a heavy financial burden and are in dire need of government support to help with medical costs. At present, the implementation of social medical welfare policies for patients with severe mental disorders in China has been ineffective. This study aims to study the participation preferences of patients for these policies, and provide a basis for the next path of policies improvement.Methods A questionnaire using the discrete choice experiment has been designed. Conditional logit regression and mixed logit regression models have been constructed based on the choice preference data, while relative importance and scenario prediction analysis have been adopted to measure the emphasis level of policy attributes in patients' minds.Results All four policy attributes affect patients' preferences for policy participation, while the attributes in descending order of relative importance are starting payment line(29.10%), reimbursement rate(25.40%), drug catalogue(24.19%), and designated medical institutions(21.31%).Patients significantly preferred the policy option with no starting payment line (p < 0.01). There are also differences in the attributes that patients with different characteristics consider critical when making choices.Conclusion This study has measured demand-side preferences for policy participation from the patient's perspective. The important finding obtained is that patients' preferences for policies attributes are closely influenced by the actual details of the policies in which they are currently or have previously participated and by their level of awareness at the time they make their judgments. The direction of policies adjustment can be grasped accordingly.

Background:Integrated care (IC) is the cornerstone of the sustainable development of the medical and health system. A thorough examination of the existing scientific literature on IC is essential for assessing the present state of knowledge on this subject. This review seeks to offer an overview of evidence-based knowledge, pinpoint existing knowledge gaps related to IC, and identify areas requiring further research. Methods:Data were retrieved from the Web of Science Core Collection, from 2010 to 2020. Bibliometrics and social network analysis were used to explore and map the knowledge structure, research hotspots, development status, academic groups and future development trends of IC. Results:A total of 7,501 articles were obtained. The number of publications on IC was rising in general. Healthcare science services were the most common topics. The United States contributed the highest number of articles. The level of collaboration between countries and between authors was found to be relatively low. The keywords were stratified into four clusters: IC, depression, integrative medicine, and primary health care. In recent years, complementary medicine has become a hotspot and will continue to be a focus. Conclusion:The study provides a comprehensive analysis of global research hotspots and trends in IC, and highlights the characteristics, challenges, and potential solutions of IC. To address resource fragmentation, collaboration difficulties, insufficient financial incentives, and poor information sharing, international collaboration needs to be strengthened to promote value co-creation and model innovation in IC. The contribution of this study lies in enhancing people's understanding of the current state of IC research, guiding scholars to discover new research perspectives, and providing valuable references for researchers and policymakers in designing and implementing effective IC strategies.

目的:通过调查北京市城镇职工参保者个人账户的使用情况和改革意愿,为确保职工医保门诊共济保障工作顺利开展提供参考建议.方法:开展问卷调查,采用SPSS 26.0对数据进行描述性分析和卡方检验,根据统计分析结果,获取不同特征调查对象对个人账户改革的看法和建议.结果:北京市个人账户结余远低于全国水平;受访者的年龄、受教育程度、就业状况和慢性病诊断情况在一定程度上影响其对个人账户的使用情况和支付改革意愿.结论:北京市改革个人账户,进行专款专用,得到了绝大多数参保人的认可,建议持续完善相关配套政策措施,保障参保职工的基本权益.

Background Previous studies have demonstrated the effect of socioeconomic status on the health status of the elderly. Nevertheless, the specific dimensions of the effect and the mechanism await further investigation. In this study, socioeconomic status was divided into three dimensions and we used social participation as the mediation variable to investigate the specific path of effect. Methods Using the 2018 Waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, a total of 10,197 effective samples of the elderly over 65 years old were screened out. Socioeconomic status included income, education level, and main occupation before retirement. The physical health and mental health of the elderly was measured by the Instrumental Activities of Daily Living Scale and the Minimum Mental State Examination, respectively. The social participation of the elderly was the mediation variable, including group exercise, organized social activities and interacting with friends. Omnibus mediation effect analysis was adopted to examine the mediation effect and mediation analysis was completed using the SPSS PROCESS program. Results First, the results showed that when the income gap between the elderly reached a certain level, there was a significant difference in health status. Significant differences existed in health status amongst with different education levels. There was no sufficient evidence to show that occupation has a significant effect on the physical health. But when the dependent variable was mental health, the effect was significant. Second, group exercise mediated 64.11% (a i b = 0.24, 95% CI [0.17,0.3]) and up to 20.44% (a i b = 0.12, 95% CI [0.07,0.17]) of the disparity in physical and mental health due to income gap, respectively. And it could mediate the effect up to 56.30% (a i b = 0.62, 95% CI [0.52,0.73]) and 17.87% (a i b = 0.50, 95% CI [0.4,0.61]) of education on physical and mental health status, respectively. The proportion of relative mediation effect of occupation was up to 28.74% (a i b = 0.19, 95% CI [0.13,0.25]) on mental health. Interacting with friends mediated only on the path that the education affected the health status of the elderly. The proportion was up to 33.72% (a i b = 0.29, 95% CI [0.16,0.44]). The relative mediation effect of organized social activities on the health gap caused by income or education level gap was significant at some levels. The proportion was up to 21.20% (a i b = 0.33, 95% CI [0.26,0.4]). Conclusion The SES of the elderly including relatively large income gap, different education levels and occupational categories could indeed have a significant effect on health status of the elderly, and the reason why this effect existed could be partly explained by the mediation effect of social participation. Policymakers should pay more attention to the social participation of the elderly.

Background Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emergency visits using both structured data and free-text data from a national survey. Methods We performed a secondary data analysis on the 2005-2017 United States National Hospital Ambulatory Medical Care Survey (NHAMCS) data to estimate the association between emergency department (ED) patients with the diagnosis of AA, and the demographic and clinical factors present at ED visits during a patient's ED stay. We used binary logistic regression (LR) and random forest (RF) models incorporating natural language processing (NLP) to predict AA diagnosis among patients with undifferentiated symptoms. Results Among the 40,441 ED patients with assigned International Classification of Diseases (ICD) codes of AA and appendicitis-related symptoms between 2005 and 2017, 655 adults (2.3%) and 256 children (2.2%) had AA. For the LR model identifying AA diagnosis among adult ED patients, the c-statistic was 0.72 (95% CI: 0.69-0.75) for structured variables only, 0.72 (95% CI: 0.69-0.75) for unstructured variables only, and 0.78 (95% CI: 0.76-0.80) when including both structured and unstructured variables. For the LR model identifying AA diagnosis among pediatric ED patients, the c-statistic was 0.84 (95% CI: 0.79-0.89) for including structured variables only, 0.78 (95% CI: 0.72-0.84) for unstructured variables, and 0.87 (95% CI: 0.83-0.91) when including both structured and unstructured variables. The RF method showed similar c-statistic to the corresponding LR model. Conclusions We developed predictive models that can predict the AA diagnosis for adult and pediatric ED patients, and the predictive accuracy was improved with the inclusion of NLP elements and approaches.

BackgroundChronic kidney disease (CKD) has become a major public health problem worldwide and has caused a huge social and economic burden, especially in developing countries. No previous study has used machine learning (ML) methods combined with longitudinal data to predict the risk of CKD development in 2 years amongst the elderly in China.MethodsThis study was based on the panel data of 925 elderly individuals in the 2012 baseline survey and 2014 follow-up survey of the Healthy Aging and Biomarkers Cohort Study (HABCS) database. Six ML models, logistic regression (LR), lasso regression, random forests (RF), gradient-boosted decision tree (GBDT), support vector machine (SVM), and deep neural network (DNN), were developed to predict the probability of CKD amongst the elderly in 2 years (the year of 2014). The decision curve analysis (DCA) provided a range of threshold probability of the outcome and the net benefit of each ML model.ResultsAmongst the 925 elderly in the HABCS 2014 survey, 289 (18.8%) had CKD. Compared with the other models, LR, lasso regression, RF, GBDT, and DNN had no statistical significance of the area under the receiver operating curve (AUC) value (>0.7), and SVM exhibited the lowest predictive performance (AUC = 0.633, p-value = 0.057). DNN had the highest positive predictive value (PPV) (0.328), whereas LR had the lowest (0.287). DCA results indicated that within the threshold ranges of ~0–0.03 and 0.37–0.40, the net benefit of GBDT was the largest. Within the threshold ranges of ~0.03–0.10 and 0.26–0.30, the net benefit of RF was the largest. Age was the most important predictor variable in the RF and GBDT models. Blood urea nitrogen, serum albumin, uric acid, body mass index (BMI), marital status, activities of daily living (ADL)/instrumental activities of daily living (IADL) and gender were crucial in predicting CKD in the elderly.ConclusionThe ML model could successfully capture the linear and nonlinear relationships of risk factors for CKD in the elderly. The decision support system based on the predictive model in this research can help medical staff detect and intervene in the health of the elderly early.

Background The strategy of successful ageing is an important means to deal with the challenges of the current ageing society. This paper aims to explore the effects of different intensities of physical activity on the successful ageing of the elderly. Methods Our data were from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), involving 9026 residents aged 60 years and older. The intensity of physical activity was divided into three levels: vigorous, moderate and mild. The concept of successful ageing adopted a four-dimensional model of life satisfaction added to the theoretical model of Rowe and Kahn’s. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of different intensities of physical activity. Results The percentage of successful ageing was 1.88% among all subjects. Among them, 30.26, 29.57 and 29.40% of the elderly often participated in vigorous, moderate and mild physical activity, respectively. The results of PSM showed that participation in moderate activity increased the probability of successful ageing of the elderly by 0.76–0.78% ( P < 0.001), while participation in vigorous and mild physical activity had no significant effect on successful ageing ( P > 0.05). Moderate physical activity had statistically significant effects on four components of successful aging, including major disease, physical function, life satisfaction, and social participation ( P < 0.05). Conclusion Moderate-intensity physical activity was most beneficial to the successful ageing of the elderly and should be promoted in the elderly population.

BackgroundReceiving informal care from family members is the mainstream way of care for the elderly in China because of the influence of the culture of filial piety. However, the relationship between informal care and health care use in urban and rural areas needs to be further explored. This study aimed to understand the effect of informal care on health care utilisation for the elderly and explore how this effect differ between urban and rural China.MethodA total of 5704 residents aged 65 years and above were selected from the wave 3 (2015) and wave 4 (2018) of the China Health and Retirement Longitudinal Study, which is a nationally representative survey. A negative binomial regression model for panel data was used to explore the relationship between informal care and health care utilisation. Besides, a fixed-effect binary choice model for panel data was used for sensitivity test.ResultThe elderly who received informal care had an increase in outpatient and inpatient visits compared with those who did not receive. The inpatient visits of the elderly who received 15–29 days of informal care was higher (incidence rate ratio [IRR] = 2.082, P < 0.05). In addition, the elderly who received informal care for more than 30 days had 39.6% more inpatient visits (IRR = 1.396, P < 0.01) and 37.4% more outpatient visits than the elderly who did not receive informal care (IRR = 1.374, P < 0.05). For urban respondents, receiving informal care can facilitate outpatient use of the elderly, but for rural respondents, receiving informal care can predict an increase in outpatient and inpatient visits.ConclusionThe impact of informal care on health care utilisation varies between rural and urban residents. Relevant departments should pay attention to the differences in the medical service utilisation amongst different elderly groups and gradually reduce the medical inequality of the elderly.

背景 随着中国社会老龄化的进一步加深,近年来政府正积极推行以社区为基础的老年人健康支持模式,但是不同的社区健康支持服务与老年人健康状况的相关关系尚不明了,缺乏较为系统的研究.目的 探究当前不同形式的社区健康支持服务与老年人自评健康状况之间的相关性,为完善社区健康支持服务提供思路.方法 数据来源于"中国老年健康影响因素跟踪调查(CLHLS)"2018年截面数据,共纳入8860例有效样本,采用倾向得分匹配(PSM)分析社区提供的起居照料、心理健康支持、上门看病和送药及健康宣教四类健康支持服务的提供与老年人自评健康状况的相关性.使用核匹配方法进行处理组(老年人所在社区提供健康支持服务)与对照组(老年人所在社区未提供健康支持服务)的匹配,默认使用二次核,带宽设定为0.06,应用K近邻匹配和半径匹配进行稳健性检验.结果 8860例老年人自评健康状况平均得分为(3.43±0.90)分,处于一般水平.4类社区健康支持服务供给情况:887例(10.01％)老年人所在社区提供起居照料服务,3111例(35.11％)老年人所在社区提供上门看病和送药服务,1271例(14.35％)老年人所在社区提供精神慰藉和聊天解闷服务,3824例(43.16％)老年人所在社区提供保健知识.不同现居地类别(城乡)、所在地区(东、中、西部地区)4类社区健康支持服务供给情况比较,差异有统计学意义(P<0.05).PSM分析显示,社区是否提供起居照料服务与老年人自评健康状况相关,处理组老年人自评健康得分比对照组高出0.123分(ATT=0.123,P<0.05),社区是否提供上门看病和送药服务与老年人自评健康状况之间无相关性(ATT=0.012,P>0.05),社区是否提供精神慰藉和聊天解闷服务与老年人自评健康状况之间相关(ATT=0.083,P<0.05),社区是否提供保健知识服务与老年人自评健康状况之间无相关性(ATT=-0.017,P>0.05).异质性检验发现,4类健康支持服务与不同性别、年龄、学历、地区等各亚组老年群体自评健康状况的相关性检验结果与总体情况基本一致.相比于其他群体,东部城市社区、家庭年收入越高、学历越高的老年人越容易在社区健康支持服务中获益.结论 参与式的健康管理服务比被动接受式服务更有利于保持或提升老年人健康水平;社区应进一步丰富基本医疗卫生服务的供给模式,促进医疗与养老服务加速融合;推动社区健康支持服务从"大水漫灌"式逐渐走向精准化.

目的:探寻分级诊疗背景下国内不同类型医疗机构患者就诊量、收支与患者就医费用的变化情况.方法:对2015-2019年《中国卫生健康统计年鉴》和《中国卫生和计划生育统计年鉴》中不同级别、不同注册类型医疗机构的患者就诊量、医疗收入与支出和患者医药费用方面的数据进行比较分析.结果:2014-2018年,三级医院诊疗人次数年均增长最大,乡镇卫生院服务量年均增长较小,民营医院服务量年均增长大于公立医院;三级医院服务量占比逐步高于二级、一级医院,乡镇卫生院住院服务占比下降.社区卫生服务中心医疗收入与支出年均增长较大,乡镇卫生院较小;乡镇卫生院医疗收入与支出占比略微下降,非公立医疗机构占比上升;公立医院收入年均增长率低于其医疗业务成本.患者次均医药费用有所增长,社区卫生服务中心门诊次均医药费、乡镇卫生院住院次均医药费年均增长较大.结论:居民就医需求仍然趋高;非公立医疗机构发展迅速,医疗成本增加;患者就医费用仍有上涨.建议深化医联体建设、明确医疗机构功能定位、合理资源布局、严格监督考核并完善医保制度,促使患者合理就医,控制费用增长.

目的:根据协调发展理论构建社会经济与卫生资源投入协调发展评价指标体系,探索我国各省(自治区、直辖市)社会经济发展与卫生资源投入的相互作用及其与健康水平的关系.方法:采用熵权法计算社会经济与卫生资源各项指标权重,利用协调发展度模型对我国31个省(自治区、直辖市)的社会经济与卫生资源的协调发展水平进行地区差异分析和纵向动态分析.结果:(1)2010—2018年,不同省(自治区、直辖市)社会经济和卫生资源各项指标权重出现变化,整体特征发生改变.(2)2012—2018年,东、中部社会经济与卫生资源差距不断增加,西部差距减小.(3)地区分布上,大部分省(自治区、直辖市)协调发展度在0.40～0.59之间,属于过渡发展类.纵向发展上,2010年的协调发展度最高,后8年间先下降后上升,但贵州、青海、宁夏、西藏、海南边远地区协调发展度在逐年上升.(4)围产儿死亡率和孕产妇死亡率与协调发展度呈现一定的负向关系,在中部和西部表现更加明显.结论:我国31个省(自治区、直辖市)整体协调发展水平一般,中部协调发展度较高,东部和西部协调发展度的内部差异较大;协调发展度对健康水平有一定的解释力度.需进一步调整卫生资源投入,提高精准性和动态性;关注区域间卫生服务的交互需求,改善卫生资源投入公平性.

BACKGROUND:Early detection of potential depression among elderly people is conducive for timely preventive intervention and clinical care to improve quality of life. Therefore, depression prediction considering sequential progression patterns in elderly needs to be further explored.METHODS:We selected 1,538 elderly people from Chinese Longitudinal Healthy Longevity Study (CLHLS) wave 3-7 survey. Long short-term memory (LSTM) and six machine learning (ML) models were used to predict different depression risk factors and the depression risks in the elderly population in the next two years. Receiver operating curve (ROC) and decision curve analysis (DCA) were used to evaluate the prediction accuracy of the reference model and ML models.RESULTS:The area under the ROC curve (AUC) values of logistic regression with lasso regularisation (AUC=0.629, p-value=0.020) was the highest among ML models. DCA results showed that the net benefit of six ML models was similar (threshold: 0.00-0.10), the net benefit of lasso regression was the largest (threshold: 0.10-0.17 and 0.22-0.25), and the net benefit of DNN was the largest (threshold: 0.17-0.22 and 0.25-0.40). In two ML models, activities of daily living (ADL)/ instrumental ADL (IADL), self-rated health, marital status, arthritis, and number of cohabiting were the most important predictors for elderly with depression.LIMITATIONS:The retrospective waves used in the LSTM model need to be further increased.CONCLUSION:The decision support system based on the proposed LSTM+ML model may be very valuable for doctors, nurses and community medical providers for early diagnosis and intervention.

目的:探索我国农村人口贫困发生率的空间分布特征;采用空间计量方法分析社会经济、卫生资源因素对农村贫困发生率的影响.方法:通过计算全局莫兰指数和局部莫兰指数描述区域农村贫困发生率的空间相关性;并通过空间计量模型对相关变量进行空间面板检验.结果:我国农村贫困发生率存在空间相关;各省(市)农村贫困发生率不仅受到本省(市)城镇化水平、平均受教育年限、农村居民年人均可支配收入、农村孕产妇死亡率、基层卫生机构数、每千农村人口拥有床位数的影响,同时也受到邻近省(市)农村居民年人均可支配收入和每千农村人口拥有床位数的影响.结论:我国农村贫困发生率具有较强的空间正相关性.社会经济发展和人口健康素质提升有利于减少农村贫困发生.卫生资源配置可能通过人群健康需求释放而对贫困发生产生双重影响,需要关注邻近地区资源配置和服务利用可能产生的“马太效应”.

This study aimed to explore the impact of social participation (SP) on physical functioning and depression among empty-nest elderly taking part in the fourth wave of the China Health and Retirement Longitudinal Survey (CHARLS, 2018). The instrumental variable (IV) method and propensity score matching (PSM) method were used to analyse the impact of SP. The two-stage regression results of the IV method showed that SP has a significant negative impact on the physical functioning scores of empty-nest elderly (β = −3.539, p < 0.001) and non-empty-nest elderly (β = −4.703, p < 0.001), and SP has a significant negative impact on the depression scores of empty-nest elderly (β = −2.404, p < 0.001) and non-empty-nest elderly (β = −1.957, p < 0.001). The results of the PSM method were basically consistent with the IV method. Compared with non-empty-nest elderly, SP had more positive effects on the depression of empty-nest elderly (Wald χ2 = 6.62, p = 0.010). Providing a friendly and supportive environment for the SP of empty-nest elderly was an important measure to promote healthy ageing. Targeted SP may be one of the greatest opportunities to improve the mental health of empty-nest elderly.