BACKGROUND: Since 2020, China has piloted an innovative payment method known as the Diagnosis-Intervention Packet (DIP). This study aimed to assess the impact of the DIP on inpatient volume and bed allocation and their regional distribution. This study investigated whether the DIP affects the efficiency of regional health resource utilization and contributes to disparities in health equity among regions.
METHODS: We collected data from a central province in China from 2019 to 2022. The treatment group included 508 hospitals in the pilot area (Region A, where the DIP was implemented in 2021), whereas the control group consisted of 3,728 hospitals from non-pilot areas within the same province. We employed the difference-in-differences method to analyze inpatient volume and bed resources. Additionally, we conducted a stratified analysis to examine whether the effects of DIP implementation varied across urban and rural areas or hospitals of different levels.
RESULTS: Compared with the non-pilot regions, Region A experienced a statistically significant reduction in inpatient volume of 14.3% (95% CI 0.061-0.224) and a notable decrease of 9.1% in actual available bed days (95% CI 0.041-0.141) after DIP implementation. The study revealed no evidence of patient consultations shifting from inpatient to outpatient services due to the reduction in hospital admissions in Region A after DIP implementation. Stratified analysis revealed that inpatient volume decreased by 12.4% (95% CI 0.006-0.243) in the urban areas and 14.7% in the rural areas of Region A (95% CI 0.051-0.243). At the hospital level, primary hospitals experienced the greatest impact, with a 19.0% (95% CI 0.093-0.287) decline in inpatient volume. Furthermore, primary and tertiary hospitals experienced significant reductions of 11.0% (95% CI 0.052-0.169) and 8.2% (95% CI 0.002-0.161), respectively, in actual available bed days.
CONCLUSIONS: Despite efforts to curb excessive medical service expansion in the region following DIP implementation, large hospitals continue to attract a large number of patients from primary hospitals. This weakening of primary hospitals and the subsequent influx of patients to urban areas may further limit rural patients\' access to medical services. The implementation of the DIP may raise concerns about its impact on health care equality and accessibility, particularly for underserved rural populations.

OBJECTIVE: Informal care provided by adult children is of great importance for older adults\' well-being in China. This paper investigates and compares the functional transitions among older adults living in rural areas who receive care from daughters\' and from sons\' families.
METHODS: This study utilizes the \'Well-being of Elderly Survey in Anhui Province\' (WESAP), from 2001 to 2021. Our sample included 2,797 individuals aged 60 years or over. Functional status was based on the activities of daily living (ADLs) and the instrumental activities of daily living (IADLs). We employed a random-effects ordered logit model to examine the functional transitions among the older adults.
RESULTS: Receiving care from daughters\' families is significantly associated with a lower likelihood of functional decline compared to receiving care from sons\' families in rural China. The advantage associated with daughter care becomes more pronounced among older individuals with a severe functional difficulty compared to those with a mild or moderate functional difficulty. The difference is prevalent among older adults aged 75 and above, with less wealth or multiple chronic diseases, or who live alone. Furthermore, among those with severe functional difficulties, the daughter advantage is more significant for fathers as compared to mothers.
CONCLUSIONS: Nowadays, daughters\' families can provide high-quality informal care, often surpassing that offered by sons\' families. This daughter advantage becomes even more significant among older adults who have a higher need for family care, such as those with severe disabilities and limited financial resources.

OBJECTIVE: This study aimed to evaluate the burden of kidney dysfunction (KD), assess socioeconomic inequalities, and project trends in the future.
METHODS: Data on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were from Global Burden of Disease Study 2019. The Joinpoint regression model was utilized to analyze the temporal trend by the annual percentage change (APC). The slope index and concentration index were employed to evaluate cross-country disparities. The future trend was predicted using an age-period-cohort analysis.
RESULTS: In the past three decades, the death numbers of KD increased from 1,571,720 to 3,161,552, DALYs from 42,090,331 to 76,486,945, YLDs from 5,003,267 to 11,282,484, and YLLs from 37,087,065 to 65,204,461, respectively. The age-standardized rate (ASR) of deaths, DALYs, and YLLs exhibited a declining trend. The ASR of YLDs increased until 2017, then decreased. The slope index and concentration index for DALYs increased from 248.1 to 351.9 and from 40.70 to 57.8. In the future, the ASR of deaths, DALYs, YLDs, and YLLs will remain stable, while their numbers will continue to rise, except for YLLs.
CONCLUSIONS: The disease burden of KD remained serious. Tailored interventions should be developed based on national contexts.

UNASSIGNED: Migration-related factors, such as language barriers, can be relevant to the risk, healthcare and complications of type 2 diabetes in people with a history of migration. Diabetes-related data from people with selected citizenships were analysed on the basis of the nationwide survey German Health Update: Fokus (GEDA Fokus).
UNASSIGNED: The diabetes risk of persons without diabetes (n = 4,698, 18 - 79 years), key figures on healthcare and secondary diseases of persons with type 2 diabetes (n = 326, 45 - 79 years) and on concomitant diseases (n = 326 with type 2 diabetes compared to n = 2,018 without diabetes, 45 - 79 years) were stratified according to sociodemographic and migration-related characteristics.
UNASSIGNED: Better German language proficiency is associated with a lower risk of diabetes. Diabetes-related organ complications are observed more frequently in persons who report experiences of discrimination in the health or care sector. Both persons with and without diabetes are more likely to have depressive symptoms when they reported experiences of discrimination. A stronger sense of belonging to the society in Germany is associated with reporting depressive symptoms less often in people without diabetes, but not in people with type 2 diabetes.
UNASSIGNED: The differences according to migration-related characteristics indicate a need for improvement in the prevention and care of type 2 diabetes. Migration-sensitive indicators should be integrated into the surveillance of diabetes.

OBJECTIVE: Evidence on whether the immigrant health paradox (i.e., immigrants having better health than natives of nonmigrant background) extends to children and youth is mixed and often based on self-reported survey data. In this study, we use population-wide administrative microdata from Norwegian demographic and health registries to investigate health inequalities between adolescents with foreign-born and native-born parents, paying specific attention to variation across immigrant generations, origin countries, and types of diagnoses.
METHODS: In this registry-based study, we estimate differences in the likelihood of somatic and mental disorders using logistic regression and population-wide health records for adolescents aged 16-20 years (N = 616,835).
RESULTS: Child immigrants and native-born children of immigrants have fewer consultations for somatic and psychiatric diagnoses in adolescence compared to natives, while native-born children with mixed parental background have health outcomes more similar to natives. The differences are most pronounced for mental disorders. Differences across immigrant generations persist when stratifying by country of origin and when looking at specific diagnoses.
CONCLUSIONS: The findings support the existence of an immigrant health advantage, which we find across various psychiatric and somatic diagnoses and for most immigrant generations. A key task for future research is to explore specific mechanisms underlying these patterns and to address potential inequities in the quality of health care provided to immigrant-background youth.

BACKGROUND: Obstructed labor (OL) and uterine rupture (UR) are common obstetric complications. This study explored the burden, risk factors, decomposition, and health inequalities associated with OL and UR to improve global maternal health.
METHODS: This was a cross-sectional analysis study including data on OL and UR from the Global Burden of Diseases, and Risk Factors Study (GBD) 2019. The main outcome measures included the number and age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), prevalence, and deaths.
RESULTS: The global burden of OL and UR has declined, with a decrease in incidence (number in 2019: 9,410,500.87, 95%UI 11,730,030.94 to 7,564,568.91; ASR in 2019: 119.64 per 100,000, 95%UI 149.15 to 96.21; estimated annual percentage change [EAPC] from 1990 to 2019: -1.34, 95% CI -1.41 to -1.27) and prevalence over time. However, DALYs (number in 2019: 999,540.67, 95%UI 1,209,749.35 to 817,352.49; ASR in 2019: 12.92, 95%UI 15.63 to 10.56; EAPC from 1990 to 2019: -0.91, 95% CI -1.26 to -0.57) and deaths remain significant. ASR of DALYs increased for the 10-14 year-old age group (2.01, 95% CI 1.53 to 2.5), the 15-19 year-old age group (0.07, 95% CI -0.47 to 0.61), Andean Latin America (3.47, 95% CI 3.05 to 3.89), and Caribbean (4.16, 95% CI 6 to 4.76). Iron deficiency was identified as a risk factor for OL and UR, and its impact varied across different socio-demographic indices (SDIs). Decomposition analysis showed that population growth primarily contributed to the burden, especially in low SDI regions. Health inequalities were evident, the slope and intercept for DALYs were - 47.95 (95% CI -52.87 to -43.02) and - 29.29 (95% CI -32.95 to -25.63) in 1990, 39.37 (95%CI 36.29 to 42.45) and 24.87 (95%CI 22.56 to 27.18) in 2019. Concentration indices of ASR-DALYs were - 0.2908 in 1990 and - 0.2922 in 2019.
CONCLUSIONS: This study highlights the significant burden of OL and UR and emphasizes the need for continuous efforts to reduce maternal mortality and morbidity. Understanding risk factors and addressing health inequalities are crucial for the development of effective interventions and policies to improve maternal health outcomes globally.

OBJECTIVE: Whilst there is a relationship between health literacy and health outcomes, the importance of social and personal demographic characteristics remains understudied., Identifying the factors responsible for creating health literacy challenges would help ensure that responses are tailored to individual or community needs.
METHODS: This survey included questions from five domains from the Health Literacy Questionnaire. Descriptive analyses and hierarchical regression were used to explore the relationship between the demographic characteristics and health literacy. Qualitative questions were subjected to thematic analysis, to identify the current barriers and proposed solutions.
RESULTS: A total of 255 participants completed the survey. Demographic characteristics that significantly predicted lower Health Literacy Questionnaire scores were having one or more chronic health conditions and living in an area of more socioeconomic disadvantage. Participants found \'navigating the health care system\' the most difficult of the five elements measured. A total of 276 individual barriers to health literacy were identified and 162 solutions proposed.
CONCLUSIONS: This study provides an overview of our sample\'s health literacy and how their social demographic characteristics may predict their health literacy challenges. Findings from this study can be used to develop targeted interventions to respond to specific health literacy challenges identified within this population. SO WHAT?: Distinct from other research, whereby solutions are proposed by researchers, the participants in this study were encouraged to share their health literacy challenges and outline potential solutions to address these in their local context.

BACKGROUND: Patients with symptomatic cholelithiasis are often discharged from the Emergency Department (ED) and asked to follow-up for elective cholecystectomy. We aimed to identify the social determinants of health (SDOH) that serve as barriers to elective cholecystectomy and to assess the associated impact on patient outcomes.
METHODS: We conducted a multi-institutional, retrospective cohort study of patients discharged from the ED with symptomatic cholelithiasis. Univariable logistic regression was used to assess for variables associated with re-presenting to the ED rather than for elective cholecystectomy. P values ​< ​0.05 identified significance.
RESULTS: Univariate analysis identified lack of a primary care physician, Black race, self-pay, language other than English as the primary language, and unemployed status to be independently associated with re-presentation to the ED for biliary disease.
CONCLUSIONS: Socially disadvantaged populations would benefit from surgery at the time of presentation to the ED versus being sent home for elective follow-up.

The aim of this study was to examine the association between health vulnerability and food consumption according to the NOVA classification within primary care in a major Brazilian city. A cross-sectional study was conducted among adults over 20 years old. These participants were part of a representative sample from the Health Academy Program (PAS) in Belo Horizonte, Brazil. We evaluated socio-demographic variables, self-reported illnesses, perceived health and quality of life, and the length of participation in PAS. Health vulnerability was gauged through the Health Vulnerability Index (HVI), which is calculated for each census sector and classified as low, medium, and high/very high. On the other hand, food consumption was determined by evaluating the average consumption described in a 24 h diet recall (24HR) and categorizing it under the NOVA classification: culinary preparations, processed foods, and ultra-processed foods (UPFs). The average calorie intake was 1429.7 kcal, primarily from culinary preparations (61.6%) and UPFs (27.4%). After adjustments, individuals residing in high/very high-HVI areas consumed more culinary preparations (β = 2.7; 95%CI: 4.7; 0.7) and fewer UPFs (β = -2.7; 95%CI: -4.7; -0.7) compared to those from low-vulnerability areas. PAS participants residing in more vulnerable areas reported healthier dietary habits, consuming more homecooked meals and fewer UPFs. These findings underscore the importance of concentrating efforts on promoting and preserving healthy eating habits and emphasizing the value of home cooking in the most vulnerable regions.

Particulate matter pollution (PMP) has been identified as a substantial contributor to cancer. However, accurately delineating the evolving trends in cancer burden attributable to PMP remains an ongoing challenge. The 1990-2019 disability-adjusted life years (DALYs) were used for cancers attributable to PMP from the Global Burden and Disease Study (GBD) 2019, including ambient particulate matter pollution (APMP) and household air pollution from solid fuels (HAP). The joinpoint regression and the Bayesian age-period-cohort (BAPC) model were employed to assess the corresponding trends over the periods 1990-2019 and 2020-2050, respectively. Additionally, statistical models such as frontier analysis and health inequality analysis were also utilized. During the 30-year period, cancer DALYs attributable to APMP increased globally, while those attributable to HAP and PMP decreased. Cancer DALYs attributable to APMP were positively correlated with socio-demographic index (SDI), while those attributable to PMP and HAP were negatively correlated with SDI. Frontier analysis identified the countries and regions requiring urgent action to mitigate PMP-attributable cancer. Finally, it was anticipated that the cancer burden attributable to APMP would increase during 2020 to 2050, while the burden attributable to HAP and PMP would decrease. This study conducted an epidemiological investigation of the burden of cancer attributable to APMP, HAP and PMP in various regions and populations worldwide, providing epidemiological insights into the global burden of cancer attributable to PMP and guiding policy and research directions.