Yixiang Huang

Thyroid cancer is the most common and rapidly increasing malignancy among adolescents and young adults (AYAs, aged 15-39 years). While this trend is well-documented, a critical gap exists in understanding how the disease burden varies with socioeconomic development. This study analyzes global disparities in the AYAs thyroid cancer burden across Socio-demographic Index (SDI) levels, identifying ecological patterns that suggest the dual challenges of overdiagnosis and inadequate care. We explored the global disparity in disease burden of thyroid cancer among AYAs utilizing the Global Burden of Disease Study 2021. Age standardized incidence rate (ASIR), age standardized prevalence rate (ASPR), age standardized mortality rate (ASMR), and age standardized disability-adjusted life years (DALYs) rate (ASDR) were extracted for analysis. Temporal trends were assessed using Average Annual Percentage Change (AAPC), estimated through joinpoint regression analysis. To further explore the relationship between development level and disease burden, restricted cubic splines were employed to model the non-linear relationship between SDI and AAPC. From 1990-2021, the global ASIR and ASPR for thyroid cancer in AYAs increased significantly (P < 0.001), with ASIR rising from 0.93 (95% UI: 0.83-1.06) to 1.59 (95% UI: 1.34-1.92) per 100,000 population. In contrast, the ASMR and ASDR remained consistently low and stable. In 2021, high SDI regions recorded the highest ASIR and ASPR, whereas low SDI regions showed the highest ASMR and ASDR. Notably, an inverse U-shaped curve was observed when exploring the correlation between SDI and the AAPC, with AAPC peaking at an SDI of approximately 0.55. Socioeconomic development acts as a double-edged sword in the AYA thyroid cancer epidemic. High-SDI regions exhibit a burden pattern indicative of potential overdiagnosis, while low-SDI regions experiencing higher mortality likely reflect gaps in timely diagnosis and care capacity. The peak burden increase at a low-middle SDI of 0.55 signals a critical transition point. These findings support differentiated strategies that emphasize diagnostic appropriateness, risk stratification, and avoidance of unnecessary detection in high-SDI regions while strengthening essential treatment capacities in resource-limited settings.

Although COPD places a significant health and economic burden on Chinese society, its associated productivity losses among working-age adults have not been estimated at the population level. Dynamic life table models, utilizing country-specific data from published literature and public datasets, estimated the gains in productivity-adjusted life-years (PALYs), and associated cost savings from preventing incident COPD among China’s working-age population (20–63 years in men and 20–58 years in women) from 2021 to 2030. Productivity losses, encompassing excess mortality, reduced labor force participation, presenteeism, and absenteeism, were aggregated to determine PALYs lost. Comparing model outputs with and without COPD incidence yielded the potential benefits of prevention. To evaluate the labor saved from preventing smoking and PM2.5 exposure, two additional analyses were conducted to estimate the productivity gains if China achieved its 2030 smoking reduction targets and if PM2.5 levels aligned with WHO guidelines. From 2021 to 2030, the projected elimination of incident COPD among China’s working-age population would yield an estimated 2.13 million PALYs gained (95% confidence interval [CI]: 1.80–2.42 million), translating to a $104.38 billion (95% CI: $88.35 - $119.03 billion) contribution to China’s GDP. For both sexes, the saved productivity derived from controlling incident COPD was consistently highest within the 55–59 age bracket, and lowest within the 25–29 age bracket. Independently, achieving recommended 2030 targets for smoking prevalence and PM2.5 levels was estimated to result in gains of 456,158 (95% CI: 439,031–472,576) and 1,091,622 (95% CI:1,057,836-1,121,879) PALYs, respectively, with corresponding economic savings of $24.33 billion (95% CI: $23.44-$25.20 billion) and $58.10 billion (95% CI: $56.36-$59.65 billion). COPD prevention extends productive life years and enhances workforce productivity across all working-age groups. Policymakers should recognize COPD’s substantial impact on labor output and implement targeted interventions to mitigate these economic losses.

Background: Both distance to the hospital and hospital reputation influence patient choice of hospital; but the combined effect of these factors and how they relate to hospitalization outcomes has yet to be determined. The purpose of this study was to assess the combined influence of distance to hospital and hospital reputation on the hospitalization outcomes in patients with stroke. Methods: This retrospective observational study utilized data from 69,107 stroke patients hospitalized in southern Chinese megacity between 2019 and 2021. A generalized linear model was used to assess the association between hospital reputation, distance to the hospital, hospitalization costs, and the length of stay. Multivariate logistic regression was used to estimate the combined effect on in-hospital mortality. Results: Compared with patients who chose hospitals without a good reputation and close to home, those who chose hospitals with a good reputation had lower hospitalization costs (−0.05; 95% CI: −0.08 to −0.02), a shorter length of stay (−0.18; 95% CI: −0.20 to −0.16), and lower in-hospital mortality (0.52; 95% CI: 0.40 to 0.67). However, patients who chose hospitals with a good reputation but farther distance experienced higher hospitalization costs (0.20; 95% CI: 0.17 to 0.23). Conclusions: A shorter distance to the hospital and a higher reputation of the hospital are associated with lower costs and better outcomes. Our study indicates that improving outcomes for patients with stroke requires equitable distribution of quality medical resources.

Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = −0.54, 95% CI: −0.94 to −0.14; β = −0.41, 95% CI: −0.78 to −0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity.

Breast cancer is the most commonly diagnosed cancer and a leading cause of death among females, with an estimated 2.3 million new breast cancer cases and 685 thousand deaths in 2020 [1]. Due to differences in the availability of early-stage screening, diagnostic procedures, and access to treatment [2,3], there are significant disparities in breast cancer […]

Household air pollution from solid cooking fuel use influences multiple health outcomes, but its association with body pain remains poorly understood. This was a longitudinal study of 8880 adults who participated in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. Household cooking fuels were extracted from the baseline household questionnaire. Transitions in cooking fuels from 2011 to 2018 were also identified. Body pain status was reported in the three waves of surveys conducted in 2011, 2015, and 2018. The associations between cooking fuel type, fuel transition, and pain site number were examined using generalized estimating equations. Among the 8880 participants, 41.4% (n = 3680) primarily used clean fuels for cooking, and 58.6% (n = 5200) used solid ones at baseline. Cooking with solid fuels was associated with more pain sites (incidence rate ratio (IRR): 1.14; 95% confidence interval (CI): 1.08 to 1.21), but a slower rate of pain sites increases from 2011 to 2018 (IRR = 0.78; 95% CI: 0.71 to 0.86, for 2018 × solid fuels). Compared with those who persistently used clean fuels for cooking, the number of pain sites increased by 10% in participants who transiting from using solid to clean fuels (IRR = 1.10; 95% CI: 1.04 to 1.18), by 21% in those transiting from cooking with clean to solid fuels (IRR = 1.21: 95% CI: 1.08 to 1.35) and by 25% among those persistent using solid fuels for cooking (IRR = 1.25; 95% CI: 1.18 to 1.34). Our findings provided new evidence linking using solid fuels for cooking with more pain sites, but a slower rate of pain sites increases. Public health efforts should focus on fuel transition and take measures to help clean fuels spread.

Background: A hospital group is an organizational integration strategy that has recently been widely implemented in Chinese urban health systems to promote integrated care. This study aims to evaluate the effect of hospital group on integrated care from the perspectives of both patients and care professionals. Methods: Two cross-sectional surveys were conducted in Shenzhen city of China, in June 2018 and July 2021. All thirty Community Health Stations (CHSs) in the hospital group were included in the intervention group, with 30 CHSs in the same district selected as the control group by simple random sampling. All care professionals within both the intervention and the control groups were invited to participate in the surveys. Twelve CHSs were selected from 30 CHSs in the intervention and the control groups by simple random sampling, and 20 patients with type 2 diabetes mellitus (T2DM) were selected from each of these selected CHSs to participate in the survey by systematic sampling. The Rainbow Model of Integrated Care-Measurement Tool (Chinese version) was used to assess integrated care. Propensity score matching and difference-in-differences regression (PSM-DID) were used to evaluate the effect of the hospital group on integrated care. Results: After matching, 528 patients and 1896 care professionals were included in the DID analysis. Results from care professionals indicated that the hospital group significantly increased technical competence of the health system by 0.771 points, and cultural competence by 1.423 points. Results from patients indicated that the hospital group significantly decreased organizational integration of the health system by 0.649 points. Conclusion: The results suggests that the effect of the hospital group on integrated care over and above routine strategies for integrated care is limited. Therefore, it is necessary to pay attention to implementing professional, clinical and other integration strategies beyond establishing hospital groups, in urban Chinese health systems.

Background: Diabetes increases the risk of hypertension morbidity, but whether this association is varied with glycemic control remains unknown. We aimed to examine the association of glycemic control with hypertension among individuals with diabetes. Methods: Data was from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2018. Participants were categorized as having adequate glycemic control (HbA1c < 7%) and inadequate glycemic uncontrol (HbA1c ≥ 7%) by combining blood glucose tests and physician’s diagnoses in 2011. Incident hypertension was ascertained through self-reported physician diagnoses from 2011 to 2018. Cox proportional hazards regression models were used to examine the effect of glycemic control on hypertension. Results: Among 436 participants with diabetes in this study, 102 met the glycemic control standard, and 334 were insufficient glycemic control. During 7 years of follow-up, 141 individuals developed hypertension. Compared with adequate glycemic control, the hazard ratio of inadequate glycemic control on hypertension was 1.54 (95% CI, 1.07–2.21) in the multivariate model. Additionally, the influence of glycemic control on hypertension varied based on educational attainment and the presence of depressive symptoms (P for interaction < 0.05). Conclusions: Insufficient glycemic control was associated with a higher risk of hypertension among individuals with diabetes. Notably, the effect of glycemic control on hypertension was more pronounced among those with lower educational attainment and those exhibiting depressive symptoms. These findings underscore the significance of vigilant glycemic monitoring, educational background considerations, and mental health assessments in managing diabetic individuals.