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Aim: To examine whether various aspects of adverse childhood experiences (ACEs) are associated with comorbid cardiovascular diseases (CVDs) and diabetes among middle‐aged and old adults in China. Methods: Using the 2018 China Health and Retirement Longitudinal Study survey and the 2014 Life History survey, in total, 17 115 respondents aged ≥45 years were included. Logistic regressions were applied to estimate the relationship between aspects of ACEs and diagnosis of both CVDs and diabetes while adjusting for adulthood demographics, health and health behaviors. Results: Childhood hunger (OR = 1.75, P < 0.01), childhood socioeconomic status (OR = 1.45, P < 0.05) and abuse from father (OR = 1.50, P < 0.05) were significantly associated with greater odds of comorbid CVDs and diabetes above and beyond adulthood characteristics. In addition, the effects of these ACEs on comorbidity were stronger than their effects on the single chronic condition. Conclusions: Our findings suggest that, for middle‐aged and old Chinese adults, ACEs could have long‐lasting impacts on multiple chronic conditions in later life. Public health interventions should focus on the early life stage as the protective childhood conditions might help in warning of later clustering chronic diseases. Geriatr Gerontol Int 2022; 22: 12–18. [ABSTRACT FROM AUTHOR]

Background: Distribution of physicians is a key component of access to health care. Although there is extensive research on urban-rural disparities in physician distribution, limited attention has been directed to the heterogeneity across urban areas. This research depicts variations in physician density across over 600 cities in the context of China's rapid urbanization. Methods: Data came from National Census Surveys and China statistical yearbooks, 2000–2003, and 2010–2013. Cities were characterized in terms of not only administrative level but also geographic regions and urban agglomerations. We analyzed variations in physician supply by applying generalized estimating equations with an ordinal logistic linking function. Results: Although overall physician density increased between 2003 and 2013, with population and socioeconomic attributes adjusted, physician density declined in urban China. On average, urban districts had a higher physician density than county-level cities, but there were regional variations. Cities in urban agglomerations and those outsides did not differ in physician density. Conclusion: Despite the reduced inequality between 2003 and 2013, the growth in physician density did not appear to be commensurate with the changes in population health demand. Assessment in physician distribution needs to take into account heterogeneity in population and socioeconomic characteristics. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate the trends and geographic variations of incident diabetes as well as the corresponding sex differences in China. Methods: The open cohort study derived data of 16,610 individuals from the China Health and Nutrition Survey 1997–2015. Direct standardisation was employed to calculate the age‐standardised diabetes incidence. Mixed effects logistic regression models with interaction terms were performed to examine variations in incident diabetes. Socio‐demographic (age, sex, marital status, racial compositions and educational attainment) and lifestyle attributes (smoking history, BMI and waist circumference) were sequentially included as covariates. Results: Overall age‐standardised diabetes incidence increased from 2.94 per 1000 person‐years (95% CI, 2.44–3.44) in 1997–2004 to 5.54 (95% CI, 4.94–6.14) in 2009–2015. Models with interaction terms suggest that the increase among men was higher than that among women (wave 2006–2009 × Female: OR = 0.45, 95% CI 0.28–0.72). Age‐standardised incidence of diabetes varied across regions, ranging from 5.67 (95% CI, 4.95–6.40) in Eastern China to 2.69 (95% CI 2.19–3.19) in Western China. Subsequent modelling analyses suggest that the geographic variations could be mostly explained by the variations in the BMI and waist circumference across regions. Conclusions: Results suggest that the incidence of self‐reported diabetes approximately doubled during the study period. The increase among men was steeper than that among women. Public interventions reducing the population's obesity level hold promise to alleviate geographic variations and flatten the growth curve. [ABSTRACT FROM AUTHOR]

Background: Prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing in China; however, awareness and knowledge of NAFLD is lacking among the Chinese public.Aims: We investigated knowledge about NAFLD and the impact of a brief educational seminar among office employees in Beijing.Methods: Educational seminar on knowledge about NAFLD and recommendations on diet and physical activity and a pre- and a post-survey in 8 offices in Beijing.Results: A total of 420 participants (24.7% with a diagnosis of NAFLD) completed both the pre- and post-surveys. Median age was 42, 39.1% were men, 93.9% participants had some college education, 50.5% were overweight/obese, and 74.9% were inactive/minimally active. Only 31.2% had awareness of NAFLD. Median baseline knowledge score (of a total of 25) was 17 in participants with and 16 in those without a diagnosis of NAFLD. After the seminar, 30.9% of participants with and 50.8% without a diagnosis of NAFLD increased their knowledge score by ≥ 3 points, and 92.9% indicated they will improve their diet and physical activity. Multivariate logistic regression analyses found baseline knowledge score was associated with personal diagnosis of NAFLD and family history of dyslipidemia while improvement in knowledge was associated with lower baseline knowledge score and absence of a personal diagnosis of NAFLD.Conclusion: We found a high prevalence but a low awareness of NAFLD among office employees in Beijing. A brief educational seminar improved knowledge about NAFLD and motivated lifestyle changes. More educational efforts are needed to decrease the burden of NAFLD in China. [ABSTRACT FROM AUTHOR]

What are the social factors that matter most to the health of elderly Chinese? Are there any gender and age differences? Using a representative sample of elderly Chinese in Shanghai, the most developed city in China with the nation’s largest proportion of elderly residents, this study found that economic conditions, chronic health status, living arrangements, social activity participation, and caring for grandchildren are factors that are most important to the health of elderly Chinese. This is true for both self-rated health and psychological well-being. The beneficial effects of participation in social activities are particularly salient for elderly women and for the old–old, whereas the salutary effects of caring for grandchildren are more substantial for elderly men and for the young–old. Our findings suggest the importance of social engagement in promoting health and successful aging of elderly Chinese and disclose the moderating roles of gender and age in this focal relationship. [ABSTRACT FROM AUTHOR]

Abstract: In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. We examine the impacts of these programs (Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS)) on health care utilization among older people in two provinces of China – Zhejiang and Gansu. The data comes from the pilot survey of the China Health and Retirement Longitudinal Study (CHARLS) collected in 2008, which contains 2685 individuals in 1570 households. We use a two-part model to analyze outpatient care. The first part is a binary equation modeling the probability of any use of outpatient service; For the second part, we use a zero-truncated Poisson model and a generalized linear model with a gamma distribution and a log link to explain the number of outpatient visits and the level of out-of-pocket (OOP) payments conditional on at least one visit to a service provider, respectively. For the inpatient care, the logistic regression is employed to predict the probability of being hospitalized. All analyses are weighted and marginal effects are reported. We find that compared with people without health insurance, people with UEBMI and URBMI are more likely to use outpatient services and people with UEBMI have less OOP payments in Zhejiang while in Gansu province, people with NCMS are less likely to have outpatient visits, while people with UEBMI are more likely to be hospitalized. In addition, among those who have at least one outpatient visit, different insurance types do not make much difference in terms of the number of outpatient visits in both provinces. Our study indicates that although the health insurance programs have some positive impacts on the health care utilization, these impacts are still limited. [Copyright &y& Elsevier]

Because the public and private sectors often operate with different goals, individuals employed by the two sectors may receive different levels of welfare. This can potentially lead to different health status. As such, employment sector offers an important perspective for understanding labor market outcomes. Using micro-level data from a recent Chinese household survey, this study empirically evaluated the impact of employment sector on health and within-sector health inequalities. It found that public sector employment generated better health outcomes than private sector employment, controlling for individual characteristics. The provision of more job security explained an important part of the association between public sector employment and better health. The study also found less health inequality by social class within the public sector. These findings suggest that policymakers should think critically about the "conventional wisdom" that private ownership is almost always superior, and should adjust their labor market policies accordingly. [ABSTRACT FROM AUTHOR]