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Urban-rural disparity in prevalence of multimorbidity in China: a cross-sectional nationally representative study.

ABSTRACT: BACKGROUND:To address the neglect of depression in multimorbidity measurement and the lack of focus on rural population in previous literature about China, this paper aimed to estimate the prevalence of multimorbidity (including depressive disorders) among the country's rural and urban population. METHODS:We used a cross-sectional design and data from a nationally representative survey conducted in 2015-2016 among Chinese people aged 45 years or older involving 19 656 participants. Multimorbidity was measured with a cut-off point of having two or more among 14 chronic illnesses. In that 13 of them were based on self-reported physician diagnosis. In addition, depressive disorders were assessed with the 10-item Centre for Epidemiologic Studies Depression Scale. The weighted prevalence of multimorbidity was calculated, with a non-response adjustment. Multivariate logistic regression was applied to analyse the relation between covariates and multimorbidity. FINDINGS:Multimorbidity was highly prevalent (54.3%) among the studied population. Contrary to previous studies, we found the prevalence of multimorbidity to be higher among the rural dwellers (58.3%) than among the urban population (50.4%). After adjustment for covariates, rural residents had 7.5% higher odds (95% CI of OR (1.003 to 1.151)) of having multimorbidity than their urban counterparts. Above 70% of patients with any of the 14 chronic illnesses above 45 years old had multimorbidity, while 80.6%-97.9% of chronic patients had multimorbidity. INTERPRETATION:Future health system development in China should transform from preventing and controlling non-communicable diseases as individual diseases to addressing people's comprehensive health needs under multimorbidity. The rural population should be prioritised as they suffered more from multimorbidity than the urban population.

SUBMITTER: Ma X

PROVIDER: S-EPMC7670952 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Urban-rural disparity in prevalence of multimorbidity in China: a cross-sectional nationally representative study.

Ma Xiaochen X He Yu Y Xu Jin J

BMJ open 20201116 11

<h4>Background</h4>To address the neglect of depression in multimorbidity measurement and the lack of focus on rural population in previous literature about China, this paper aimed to estimate the prevalence of multimorbidity (including depressive disorders) among the country's rural and urban population.<h4>Methods</h4>We used a cross-sectional design and data from a nationally representative survey conducted in 2015-2016 among Chinese people aged 45 years or older involving 19 656 participants ...[more]

PMID: 33199420

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Project description:BackgroundTobacco smoking is a leading cause of premature death in China, especially among adult men. Since the implementation of the Framework Convention on Tobacco Control in 2005, nationwide tobacco control has been strengthened, but its long-term impact on smoking prevalence is unclear.Methods and findingsFive nationally representative surveys of the China Chronic Disease and Risk Factor Surveillance (CCDRFS) were conducted in 2007, 2010, 2013, 2015, and 2018. A total of 624,568 adults (278,605 men and 345,963 women) aged 18 to 69 years were randomly selected from 31 provinces (or equivalent) in China. Temporal changes in smoking prevalence and patterns (e.g., percentages of those smoking manufactured cigarettes, amount smoked, and age at smoking initiation) were analyzed, overall and by sex, urban or rural residence, year of birth, education and occupation, using linear regression methods. Among men, the standardized prevalence of current smoking decreased from 58.4% (95% confidence interval [CI]: 56.1 to 60.7) to 50.8% (95% CI: 49.1 to 52.5, p < 0.001) between 2007 and 2018, with annual decrease more pronounced in urban (55.7% [95% CI: 51.2 to 60.3] to 46.3% [95% CI: 43.7 to 49.0], p < 0.001) than rural men (59.9% [95% CI: 57.5 to 62.4] to 54.6% [95% CI: 52.6 to 56.6], p = 0.05) and in those born before than after 1980. Among rural men born after 1990, however, the prevalence increased from 40.2% [95% CI: 34.0 to 46.4] to 52.1% ([95% CI: 45.7 to 58.5], p = 0.007), with the increase taking place mainly before 2015. Among women, smoking prevalence remained extremely low at around 2% during 2007 to 2018. No significant changes of current smoking prevalence (53.9% to 50.8%, p = 0.22) were observed in male patients with at least 1 of major chronic diseases (e.g., hypertension, diabetes, myocardial infarction, stroke, chronic obstructive pulmonary disease (COPD)). In 2018, 25.6% of adults aged ≥18 years smoked, translating into an estimated 282 million smokers (271 million men and 11 million women) in China. Across 31 provinces, smoking prevalence varied greatly. The 3 provinces (Yunnan, Guizhou, and Hunan) with highest per capita tobacco production had highest smoking prevalence in men (68.0%, 63.4%, and 61.5%, respectively), while lowest prevalence was observed in Shanghai (34.8%). Since the children and teenage groups were not included in the surveys, we could not assess the smoking trends among youths. Furthermore, since the smoking behavior was self-reported, the smoking prevalence could be underestimated due to reporting bias.ConclusionsIn this study, we observed that the smoking prevalence has decreased steadily in recent decades in China, but there were diverging trends between urban and rural areas, especially among men born after 1980. Future tobacco control strategies should target rural young men, regions with high tobacco production, and patients suffering from chronic diseases.

Project description:BackgroundThe urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas.ObjectiveThis study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use.MethodsA total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing "internet use×urban-rural status" interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed.ResultsInternet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (β=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (β=-.027, 95% CI -.043 to -.009).ConclusionsThe urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities.

Project description:To examine the effect of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines on the prevalence of hypertension and eligibility for initiation and intensification of treatment in nationally representative populations from the United States and China.Observational assessment of nationally representative data.US National Health and Nutrition Examination Survey (NHANES) for the most recent two cycles (2013-14, 2015-16) and China Health and Retirement Longitudinal Study (CHARLS) (2011-12).All 45-75 year old adults who would have a diagnosis of hypertension and be candidates for treatment on the basis of the ACC/AHA guidelines, compared with current guidelines.Diagnosis of hypertension and candidacy for initiation and intensification of antihypertensive treatment.Adoption of the 2017 ACC/AHA hypertension guidelines in the US would label 70.1 (95% confidence interval 64.9 to 75.3) million people in the 45-75 year age group as having hypertension, representing 63% (60.6% to 65.4%) of the population in this age group. Their adoption in China would lead to labeling of 266.9 (252.9 to 280.8) million people or 55% (53.4% to 56.7%) of the same age group as having hypertension. This would represent an increase in prevalence of 26.8% (23.2% to 30.9%) in the US and 45.1% (41.3% to 48.9%) in China. Furthermore, on the basis of treatment patterns and current guidelines, 8.1 (6.5 to 9.7) million Americans with hypertension are untreated, which would be expected to increase to 15.6 (13.6 to 17.7) million after the implementation of the ACC/AHA guidelines. In China, on the basis of current treatment patterns, 74.5 (64.1 to 84.8) million patients with hypertension are untreated, estimated to increase to 129.8 (118.7 to 140.9 million. In addition, the ACC/AHA guidelines would label 8.7 (6.0 to 11.5) million adults in the US and 51 (40.3 to 61.6) million in China as having hypertension that would not require antihypertensive treatment, compared with 1.5 (1.2 to 2.1) million and 23.4 (12.1 to 35.1) million with the current guidelines. Finally, even among people receiving treatment, the proportion that are candidates for intensification of treatment is estimated to increase by 13.9 (12.2 to 15.6) million (from 24.0% to 54.4% of treated patients) in the US, and 30 (24.3 to 35.7) million (41.4% to 76.2% of treated patients) in China, if the ACC/AHA treatment targets are adopted.If adopted, the 2017 ACC/AHA hypertension guidelines will markedly increase the number of people labeled as having hypertension and treated with drugs in both the US and China, leading to more than half of those aged 45-75 years in both countries being considered hypertensive.

Project description:BackgroundHypertension is a rapidly growing epidemic in China. Yet, it remains inadequately controlled, especially in rural areas. The internet has shown potential for better health management in different settings; however, few studies have investigated its role in hypertension management in China.ObjectiveThis study aims to examine the association between internet access and hypertension awareness, treatment, and control among elderly Chinese adults and to investigate whether the association between internet access and hypertension management differed between those living in urban and rural areas.MethodsWe obtained data from the nationally representative survey of the China Health and Retirement Longitudinal Study in 2011. Hypertension was defined as (1) average systolic blood pressure of ≥140 mm Hg or average diastolic blood pressure of ≥90 mm Hg or (2) currently taking antihypertensive medications. The outcome assessed included hypertension awareness, treatment, and control. The key independent variable was defined as whether one had internet access at home. We performed multivariate logistic regressions for each of the 3 outcomes.ResultsAmong 5135 hypertensive respondents (age 62.4 [SD 9.9] years; 2351/5135, 45.78% men), 12.89% (662/5135) had internet access at home. Compared with those who had no internet access, internet access was positively associated with hypertension awareness (odds ratio [OR] 1.36, 95% CI 1.07-1.73) and treatment (OR 1.38, 95% CI 1.09-1.75), but not with control (OR 1.19, 95% CI 0.90-1.58). Internet access reduced urban-rural disparity in hypertension awareness by 9.6% (P=.02), treatment by 8.3% (P=.05), but not in control. In addition, the moderating effect of internet access on urban-rural disparities in hypertension management was larger among females. The decreased urban-rural disparities were primarily driven by that internet access improved the management level in rural areas.ConclusionsDespite the low rate of internet access among the elderly population, the internet shows its potential as a platform for achieving better hypertension management in China. Strategies for reducing the disparities in hypertension management and overall disease burden of hypertension among the elderly population might consider the internet as a platform.

Dataset Information

Urban-rural disparity in prevalence of multimorbidity in China: a cross-sectional nationally representative study.

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Urban-rural disparity in prevalence of multimorbidity in China: a cross-sectional nationally representative study.

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