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Abstract：
UNASSIGNED: Prevention and control of non-communicable diseases (NCDs) become a policy priority in Universal Health Coverage (UHC) in China, while NCD management has never been comprehensively estimated at national and subnational levels. We aimed to assess NCD management in China nationally and in key subpopulations, investigate inequalities from multidimensions, and further examine its association with health financing and resources.
UNASSIGNED: Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis.
UNASSIGNED: In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC -0.1%, 95% CrI -1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively.
UNASSIGNED: The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC.
UNASSIGNED: National Natural Science Foundation of China.
UNASSIGNED: Data included were from China Chronic Disease and Risk Factors Surveillance (CCDRFS) and China Health and Nutrition Survey (CHNS). Following the WHO recommended frameworks, we selected eight NCD health service and risk management indicators and used meta-analysis to construct the composite NCD index. We explored the trends in and projections of NCD management index and indicators at national and subnational levels by using Bayesian regression models with average annual percentage change (AAPC) from 2004 to 2018 and probability of reaching the UHC target by 2030. We further conducted comprehensive inequality analyses of NCD indicators from multidimensions with patterns of changes over time using absolute difference and relative ratio. Finally, we quantified the associations between NCD management performance with health financing and resources using stochastic frontier analysis.
UNASSIGNED: In China, the NCD management index increased slowly from 62.0% (95% CI 36.0 to 84.0) in 2004 to 64.3% (95% CI 44.0 to 82.2) in 2018, with lagging performance being observed in prevention domain (AAPC -0.1%, 95% CrI -1.0 to 0.8). And all management indicators presented low probabilities of accomplishing 2030 targets in China. Notably, based on subnational analysis, diverse tendency and magnitude of inequalities in multiple NCD indicators were identified with widening gaps between genders (non-overweight, diabetes treatment), age groups (non-use of tobacco), urban-rural areas (non-use of alcohol, non-use of tobacco), regions (sufficient physical activity), and wealth quintiles (non-overweight, sufficient physical activity). Additionally, it was observed that compared with urban area, rural area had constantly lower health resources and presented 2.2% lower NCD management performance in 2018. Importantly, we found that health financing and resources especially distributed in primary health care (PHC) facilities were closely and positively associated with NCD management performance. A 1000 yuan increase of government health expenditure (GHE) per capita and a 10 increase of medical beds per 1000 capita in PHC facilities were associated with a 4.0% (95% CI 2.0 to 6.0) and 6.8% (95% CI 0.2 to 13.5) increase of NCD management index, respectively.
UNASSIGNED: The progress towards NCD management is slow at national level and in key subpopulations in China, with great challenges of existing and widening inequalities between genders, age groups, urban-rural areas, regions and socioeconomic groups. Rural and old people were still vulnerable populations who were lagging behind in NCD prevention and control. Optimising resource allocation by strengthening PHC especially in rural area, developing tailor-made programmes targeting specific populations such as old individuals, simultaneously integrating gender, education, and economic interventions to reduce inequalities should be prioritised to help China tackle NCDs during the progress towards UHC.
UNASSIGNED: National Natural Science Foundation of China.
摘要：
■预防和控制非传染性疾病（NCDs）成为中国全民健康覆盖（UHC）的政策重点，而非传染性疾病管理从未在国家和国家以下各级得到全面估计。我们旨在评估中国全国和关键亚人群的非传染性疾病管理情况，从多维度研究不等式，并进一步检查其与卫生筹资和资源的关系。
■数据来自中国慢性病和危险因素监测（CCDRFS）和中国健康与营养调查（CHNS）。根据世卫组织建议的框架，我们选取了8项NCD卫生服务和风险管理指标,采用meta分析构建了NCD综合指数.我们通过使用2004年至2018年平均年变化百分比（AAPC）的贝叶斯回归模型以及到2030年达到UHC目标的可能性，探索了国家和国家以下各级NCD管理指数和指标的趋势和预测。我们进一步从多维角度对NCD指标进行了全面的不平等分析，并使用绝对差异和相对比率随时间的变化模式。最后,我们使用随机前沿分析量化了NCD管理绩效与卫生筹资和资源之间的关联.
■在中国，NCD管理指数从2004年的62.0%(95%CI36.0至84.0)缓慢上升至2018年的64.3%(95%CI44.0至82.2)，预防领域表现滞后(AAPC-0.1%，95%CrI-1.0至0.8)。所有管理指标都显示中国实现2030年目标的可能性很低。值得注意的是,根据国家以下各级的分析，在多个非传染性疾病指标中发现了不同的不平等趋势和程度，性别之间的差距不断扩大(非超重，糖尿病治疗)，年龄组（不使用烟草），城乡地区(不使用酒精，不使用烟草)，区域（足够的身体活动），和财富五分位数(非超重，足够的身体活动)。此外,据观察，与城市地区相比，2018年，农村地区卫生资源持续减少，NCD管理绩效下降2.2%。重要的是,我们发现,尤其是在初级卫生保健(PHC)机构中分布的卫生筹资和资源与NCD管理绩效密切相关。人均政府卫生支出（GHE）增加1000元，PHC设施人均医疗床位增加10张，NCD管理指数增加4.0%（95%CI2.0~6.0）和6.8%（95%CI0.2~13.5），分别。
■在国家层面和中国的关键亚人群中，NCD管理进展缓慢，面对性别之间现有和不断扩大的不平等的巨大挑战，年龄组,城乡地区,地区和社会经济群体。农村和老年人仍然是弱势群体，在非传染性疾病预防和控制方面落后。通过加强特别是农村地区的PHC来优化资源配置，制定针对老年人等特定人群的量身定制计划，同时整合性别，教育,在实现全民健康覆盖的过程中，应优先考虑减少不平等的经济干预措施，以帮助中国应对非传染性疾病。
■国家自然科学基金.
■数据来自中国慢性病和危险因素监测（CCDRFS）和中国健康与营养调查（CHNS）。根据世卫组织建议的框架，我们选取了8项NCD卫生服务和风险管理指标,采用meta分析构建了NCD综合指数.我们通过使用2004年至2018年平均年变化百分比（AAPC）的贝叶斯回归模型以及到2030年达到UHC目标的可能性，探索了国家和国家以下各级NCD管理指数和指标的趋势和预测。我们进一步从多维角度对NCD指标进行了全面的不平等分析，并使用绝对差异和相对比率随时间的变化模式。最后,我们使用随机前沿分析量化了NCD管理绩效与卫生筹资和资源之间的关联.
■在中国，NCD管理指数从2004年的62.0%(95%CI36.0至84.0)缓慢上升至2018年的64.3%(95%CI44.0至82.2)，预防领域表现滞后(AAPC-0.1%，95%CrI-1.0至0.8)。所有管理指标都显示中国实现2030年目标的可能性很低。值得注意的是,根据国家以下各级的分析，在多个非传染性疾病指标中发现了不同的不平等趋势和程度，性别之间的差距不断扩大(非超重，糖尿病治疗)，年龄组（不使用烟草），城乡地区(不使用酒精，不使用烟草)，区域（足够的身体活动），和财富五分位数(非超重，足够的身体活动)。此外,据观察，与城市地区相比，2018年，农村地区卫生资源持续减少，NCD管理绩效下降2.2%。重要的是,我们发现,尤其是在初级卫生保健(PHC)机构中分布的卫生筹资和资源与NCD管理绩效密切相关。人均政府卫生支出（GHE）增加1000元，PHC设施人均医疗床位增加10张，NCD管理指数增加4.0%（95%CI2.0~6.0）和6.8%（95%CI0.2~13.5），分别。
■在国家层面和中国的关键亚人群中，NCD管理进展缓慢，面对性别之间现有和不断扩大的不平等的巨大挑战，年龄组,城乡地区,地区和社会经济群体。农村和老年人仍然是弱势群体，在非传染性疾病预防和控制方面落后。通过加强特别是农村地区的PHC来优化资源配置，制定针对老年人等特定人群的量身定制计划，同时整合性别，教育,在实现全民健康覆盖的过程中，应优先考虑减少不平等的经济干预措施，以帮助中国应对非传染性疾病。
■国家自然科学基金.
