BMJ public health最新文献

{"title":"Optimal risk assessment intervals for primary prevention of cardiovascular disease: a population-based two-stage landmarking study.","authors":"Zander Gu, Francesca Gasperoni, Ellie Paige, Michael Sweeting, Juliet Usher-Smith, Katrina Poppe, David Stevens, Matthew Arnold, Emanuele Di Angelantonio, Angela M Wood, Jessica K Barrett","doi":"10.1136/bmjph-2024-001241","DOIUrl":"10.1136/bmjph-2024-001241","url":null,"abstract":"<p><strong>Introduction: </strong>The recommended assessment intervals for primary prevention of cardiovascular disease (CVD) differ in major international guidelines. We aimed to provide empirical evidence on the optimal frequency of CVD risk assessment to inform future guidelines.</p><p><strong>Methods: </strong>We estimated the expected time to cross the 10-year CVD risk treatment threshold of 10% using extended two-stage landmarking for more than 2 million people using UK primary care electronic health records between April 2004 and May 2019 from the Clinical Practice Research Datalink GOLD Database (CPRD GOLD), which was linked to hospital admissions data from the Hospital Episodes Statistics (HES) dataset and national mortality records from the Office for National Statistics (ONS). We grouped people based on their sex, initial risk level and age, and computed various percentiles of the expected crossing times per group. Based on the percentiles, optimal assessment intervals were identified and their performance was evaluated comparing to the current recommended intervals in the UK.</p><p><strong>Results: </strong>Our results showed that the expected crossing times for people with lower initial risk were much longer than those with higher initial risk. Within each initial risk group, expected time to crossing the risk treatment thresholds was shorter in people aged ≥65 years. Based on the median expected crossing times, our recommended intervals for women with initial 10-year risk of 7.5%-10%, 5%-7.5%, 2.5%-5% or<2.5% are 3 (1 if ≥65 years old), 7 (4), 10 (6) and 10 (10) years, respectively; intervals for men are 2 (1), 5 (5), 9 (9) and 10 (10) years. These intervals outperformed the 5-yearly risk reassessment for all individuals currently recommended in the UK.</p><p><strong>Conclusions: </strong>Our evidence suggests that CVD risk assessment intervals for primary prevention should be stratified by sex, initial risk level and age. For the UK population, our method found risk assessment intervals that reduce the number of assessments required while shortening the waiting time to the next assessment for those most in need.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001241"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial disparities in hypertension subtype prevalence over the lifecourse: evidence of accelerated arterial ageing in a population representative cross-sectional study.","authors":"Alexis N Reeves, Michelle C Odden","doi":"10.1136/bmjph-2024-001993","DOIUrl":"10.1136/bmjph-2024-001993","url":null,"abstract":"<p><strong>Introduction: </strong>Racially minoritised populations, particularly Black individuals, have been shown to have an earlier average age of onset of hypertension (elevated systolic and/or diastolic blood pressure) compared with White individuals potentially due to 'weathering' or accelerated health declines due to the cumulative impact of marginalisation over the lifecourse. Systolic blood pressure is more reactive to stress, increases linearly with age indicative of arterial ageing and is more highly associated with cardiovascular morbidity and mortality versus diastolic blood pressure. However, little research has examined racial differences in isolated systolic hypertension. This study examines the race/gender differences in the prevalence of two mutually exclusive manifestations of hypertension: diastolic hypertension (ie, elevated diastolic with or without elevated systolic blood pressure) and isolated systolic hypertension (increased systolic only) over the lifecourse.</p><p><strong>Methods: </strong>The National Health and Nutrition Examination Survey from 2016 to 2020, a US-based population representative cross-sectional study, was used in weighted multinomial logistic regression models to estimate age-specific prevalence of hypertension subtypes by race/gender subgroups controlling for socioeconomic status and anti-hypertensive use. Outcomes were diastolic (diastolic ≥90 mm Hg with/without systolic ≥140 mm Hg) and isolated systolic (systolic ≥140 mm Hg and diastolic <90 mm Hg) hypertension.</p><p><strong>Results: </strong>The prevalence of diastolic hypertension increased until midlife and then decreased with increasing age, while the prevalence of isolated systolic hypertension increased throughout the lifecourse. Black women had nearly triple the prevalence of diastolic hypertension from 20 to 45 years where the disparity lessens to double the prevalence and continues to lessen with increasing age and 2-3 times the prevalence of isolated systolic hypertension as early as 35 years with continued disparity at older ages. Black men had nearly double the prevalence of diastolic hypertension from 35 to 65 years and at least double the prevalence of isolated systolic hypertension throughout the lifecourse with the widest disparities at 40 years. Disparities attenuated but remained statistically significant with adjustment for socioeconomic status.</p><p><strong>Conclusions: </strong>Results suggest that isolated systolic hypertension is a dominant and important form of hypertension starting in midlife (~50-60 years); however, indicative of potential earlier arterial ageing, Black men and women's increased prevalence may start as early as 35 and 45 years, respectively.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001993"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusive sexual and reproductive health services for teenage mothers: a qualitative study in a Rwandan district.","authors":"Vedaste Bagweneza, Joselyne Rugema, Innocent Twagirayezu, Bellancille Nikuze, Alice Nyirazigama, Marie Laetitia Ishimwe Bazakare, Gerard Kaberuka, Alice Muhayimana, Jacqueline Mukakamanzi, Madeleine Mukeshimana","doi":"10.1136/bmjph-2024-001852","DOIUrl":"10.1136/bmjph-2024-001852","url":null,"abstract":"<p><strong>Background: </strong>Sexual and reproductive health (SRH) plays a crucial role in overall well-being, and there is a concerning rise in teenage pregnancies globally, particularly evident in Rwanda according to the Demographic and Health Survey. These pregnancies result in serious consequences, impacting the health of teenage mothers and various aspects of their lives. Lack of accessibility to inclusive SRH services among adolescents was documented in different studies and deters them from using SRH services. To date, no studies have explored how teenage mothers access inclusive SRH services in Rwanda.</p><p><strong>Purpose: </strong>This study aimed at exploring the accessibility to inclusive SRH services among teenage mothers. The focus was on exploring the understanding of teenage mothers about SRH services; exploring their inclusiveness to SRH services and identifying their suggestions to improve their inclusiveness in SRH services.</p><p><strong>Methods: </strong>A qualitative descriptive design was used. 50 teenage mothers from 5 health centres of a Rwandan district participated. They were recruited using purposive sampling and interviewed in five focus group discussions. Before participation, the participants provided their consent. For participants who were minors, consent was obtained from their legal guardians in addition to the participants' assent. The discussions were audio-recorded, transcribed and thematically analysed.</p><p><strong>Results: </strong>Some participants had limited knowledge of certain aspects of SRH and reported difficulties accessing inclusive SRH services, while others mentioned receiving unfriendly SRH services. Participants suggested flexibility in policies related to providing SRH services to teenage mothers, as well as the assignment of specific healthcare providers to address their SRH needs.</p><p><strong>Conclusions: </strong>This study revealed knowledge gaps among participants in SRH and limited accessibility to inclusive SRH services among teenage mothers, due to policy and negative attitudes of some healthcare providers. This highlights the need to educate these professionals in offering inclusive and quality SRH services to teenage mothers.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001852"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access and benefit sharing: streamlining legal frameworks for global health equity.","authors":"Ayelet Berman, Bart Van Vooren","doi":"10.1136/bmjph-2025-002830","DOIUrl":"https://doi.org/10.1136/bmjph-2025-002830","url":null,"abstract":"","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e002830"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observational study of the pre-service vulnerabilities, in-service exposures and post-service antecedents of suicide in veterans of the UK Armed Forces, 2007-2018.","authors":"Jodie Westhead, Saied Ibrahim, Lana Bojanić, Pauline Turnbull, Louis Appleby, Andy Bacon, Harriet Dale, Kate Harrison, Nav Kapur, Cathryn Rodway","doi":"10.1136/bmjph-2024-001433","DOIUrl":"10.1136/bmjph-2024-001433","url":null,"abstract":"<p><strong>Introduction: </strong>Although there have been a number of epidemiological studies of suicide in veterans, there have been few in-depth studies of those who have died. Studies have not explored the relative contribution of pre-service, in-service and post-service factors. We aimed to investigate the adversities veterans face before they take their lives, their contact with support services that could be preventative and whether these differ in younger and older veterans.</p><p><strong>Methods: </strong>Using national databases of discharged personnel and suicide deaths, we identified deaths by suicide in personnel who left the UK Armed Forces (UKAF) between 2007 and 2018. We extracted information on the antecedents of suicide in a random sample of these deaths from official investigations, mostly coroners' records.</p><p><strong>Results: </strong>In total, we obtained data for 145 individuals; 134 (92%) were male and 11 (8%) were female. Seven (5%) were from a minority ethnic group. The median age at death was 36 years (21-65 years). 18 (12%) veterans had experienced childhood adversity. Relatively few (10, 7%) experienced trauma relating to deployment on combat operations or had difficulty adjusting to civilian life (6, 4%). Most (140, 97%) veterans had been in contact with support services, particularly primary care (130, 90%), but undertreatment was common with only 10 (5%) veterans having received psychological intervention. Unemployment, alcohol and drug misuse, mental and physical ill health, workplace, housing and relationship problems were common antecedents.</p><p><strong>Conclusions: </strong>Veterans experience a range of challenges after leaving the UKAF. Common antecedents to suicide, such as self-harm, suicidal ideation and drug misuse, are open to intervention. However, despite most veterans seeking help from a range of support services, few were receiving psychological intervention. Prevention should also focus on addressing the needs of veterans beyond mental ill health, like employment and housing.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001433"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143757154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Path to full immunisation coverage, role of each vaccine and their importance in the immunisation programme: a cross-sectional analytical study of India.","authors":"Pritu Dhalaria, Pawan Kumar, Sanjay Kapur, Ajeet Kumar Singh, Ajay Kumar Verma, Disha Agarwal, Bhupendra Tripathi, Gunjan Taneja","doi":"10.1136/bmjph-2024-001290","DOIUrl":"10.1136/bmjph-2024-001290","url":null,"abstract":"<p><strong>Introduction: </strong>Immunisation is vital in preventing infectious diseases and promoting public health. This study examines the immunisation landscape in India, focusing on absolute zero dose (defined as a child did not receive any single dose of vaccine as per the National Immunisation Schedule), antigen-wise zero dose (defined as children who did not receive any dose of specific vaccine but received some or complete dose of other vaccines), the pattern of undervaccination (defined as children who missed any one or more than one dose of vaccine from total eight doses of vaccine (one dose-BCG, three doses-DPT, three doses-OPV and one dose-measles vaccine) and immunisation cascade.</p><p><strong>Methods: </strong>Using data from the National Family Health Survey-5, we analysed the immunisation status of 43 247 children across India. The prevalence of absolute zero-dose children, antigen-wise zero dose, co-coverage rates and cascade levels for vaccine combinations are assessed. The multilevel regression model has been applied to understand the likelihood of left-out and antigen-wise zero doses by socioeconomic determinants.</p><p><strong>Results: </strong>Children lacking vaccination cards experience a higher prevalence of absolute zero dose cases (21.2%). Notably, scheduled tribes (4.1%), the Muslim group (5.4%) and the poorest wealth quintile (4.6%) exhibit the highest prevalence. Remarkably, within partially vaccinated (20%) children, 42.8% show zero dose for measles-containing vaccines, while 6.7% of children failed to achieve full immunisation coverage due to just one missed dose of vaccine. Further, 20% of the partially vaccinated subset revealed that 7.29% missed full immunisation coverage due to oral polio vaccine (OPV) dose gaps.</p><p><strong>Conclusions: </strong>Targeted efforts are essential to bridge immunisation gaps and achieve universal coverage in India. Focusing on antigen-specific zero dose and partially vaccinated children, particularly those missing OPV doses and measles vaccine offers the potential to improve full immunisation coverage. Therefore, to achieve the IA2030 requires an intensified target for reaching absolute zero and antigen-wise zero dose.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001290"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth-to-youth empowerment study to support health equity for urban American Indian/Alaska Native and Black adolescents in Denver Metro, Colorado, USA: a mixed methods, youth-centred aetiological study protocol.","authors":"Nicole Tuitt, Arionna Hall, Yazira Martinez Dominguez, Anniah Hill, Oluwafikemi Samuels, Alexander Weiden, Dustin T Duncan, Brisa Sánchez, Roland S Moore, Nancy Rumbaugh Whitesell, Carol Kaufman","doi":"10.1136/bmjph-2024-001465","DOIUrl":"10.1136/bmjph-2024-001465","url":null,"abstract":"<p><strong>Introduction: </strong>Promoting positive substance use and sexual health outcomes for urban American Indian and Alaska Native (AIAN) and Black youth requires multilevel approaches that address the underlying structural conditions that promote behavioural health inequities. However, researchers rarely employ this complex approach. Developing and operationalising a strengths-based conceptual framework grounded in the socioecological model is a critical first step to inform multilevel interventions to reduce these inequities.</p><p><strong>Methods and analysis: </strong>Guided by the socioecological model, a youth-centred mixed methods approach will be employed to develop and evaluate a comprehensive multilevel conceptual framework of risks and protective factors associated with substance misuse and adverse sexual health behaviours among AIAN and Black youth of Denver Metro, Colorado. We will use multilevel structural equation modelling, with secondary and geographical data. The secondary data include the Healthy Kids Colorado Survey data (n=631 AIAN, n=5350 Black and n=30 557 non-Hispanic white), the Colorado Department of Education School View data (n=33 schools) and the American Community Survey data (n=73 neighbourhoods). We will also engage approximately 30 youth through scenario-based interviewing to capture perspectives on the constructs that are not captured in the secondary data. The quantitative and qualitative data will be integrated to elucidate a conceptual framework that will be used to develop and optimise a multilevel intervention to reduce adverse substance use and sexual health outcomes in AIAN and Black youth in Denver Metro, Colorado.</p><p><strong>Ethics and dissemination: </strong>The results of the study will be shared at conferences, meetings and in published articles. Study findings will also be presented to the local community through presentations, social media, newsletters, flyers and brochures. The names of all participants, schools and neighbourhoods will be kept private. This study was approved by the Colorado Multiple Institutional Research Board (protocol number 21-4038).</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001465"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a biological frailty score based on CRP, haemoglobin, albumin and vitamin D within an electronic health record database in France: a cross-sectional study.","authors":"Aurélie Mailliez, Maxime Leroy, Michael Génin, Elodie Drumez, François Puisieux, Jean-Baptiste Beuscart, Ivan Bautmans, Pierre Balayé, Eric Boulanger","doi":"10.1136/bmjph-2024-001941","DOIUrl":"10.1136/bmjph-2024-001941","url":null,"abstract":"<p><strong>Objectives: </strong>To easily detect frailty in a timely fashion, enabling targeted interventions and appropriate monitoring, will be a major worldwide public health and economic challenge as the proportion of older people increases in the population. Based on a review and meta-analysis showing that C-reactive protein (CRP), haemoglobin, albumin and vitamin D are associated with frailty, we aimed to develop and validate a biological score using these biomarkers for the detection of frailty.</p><p><strong>Design: </strong>We conducted a retrospective, cross-sectional, monocentric study using the electronic healthcare database of Lille University Hospital, France.</p><p><strong>Participants: </strong>Inclusion criteria were patients aged 50 and over, being hospitalised at Lille University Hospital between 1 January 2008 and 31 December 2021. We identified patients whose CRP, haemoglobin, albumin and vitamin D levels were measured. We selected patients whose assays fell within normal thresholds, outside acute clinical situations.</p><p><strong>Main outcome measures: </strong>To assess frailty, we used a scale adapted to electronic healthcare database, called the Hospital Frailty Risk Score. To develop and validate the predictive frailty score, the whole population was divided into a development and a validation cohort.</p><p><strong>Results: </strong>26 554 patients were included, of which 17 702 were in the development cohort and 8852 in the validation cohort. Based on the results of the multivariate analysis, we developed an equation combining CRP, haemoglobin, albumin and vitamin D with age and sex to obtain a score referred to as the bFRAil (biological FRAilty) score. Within the validation cohort, the area under the curve for this score is 0.78 (0.77-0.80) and the negative predictive value is 83.7%.</p><p><strong>Conclusions: </strong>This study has made it possible, for the first time, to develop and validate in a hospital setting a biological score called bFRAil score based on simple, easily measurable biomarkers for identifying frail patients in daily medical practice. Further studies are needed to validate its use.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001941"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa.","authors":"Kennedy Bashan Nkhoma, Maya Jane Bates, Dorothee van Breevoort, Dickson Dick Chifamba, Catherine J Evans, Duncan Kwaitana, Adwoa Bemah Boamah Mensah, Modai Clement Mnenula, Lovemore Mupaza, Edwina Beryl Addo Opare-Lokko, Richard Harding","doi":"10.1136/bmjph-2024-001355","DOIUrl":"10.1136/bmjph-2024-001355","url":null,"abstract":"<p><strong>Background: </strong>The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.</p><p><strong>Methods: </strong>We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.</p><p><strong>Results: </strong>The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.</p><p><strong>Conclusion: </strong>Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001355"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of China's primary healthcare reforms on utilisation, payments and self-reported health: a quasi-experimental analysis of a middle-aged and older cohort 2011-2018.","authors":"Chang Cai, Christopher Millett, Shangzhi Xiong, Maoyi Tian, Jin Xu, Thomas Hone","doi":"10.1136/bmjph-2024-001595","DOIUrl":"10.1136/bmjph-2024-001595","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive health reforms aimed at strengthening primary healthcare (PHC) are infrequently adopted and often poorly evaluated in low-income and middle-income countries. China launched a system-wide PHC reform with a staggered roll-out between 2014 and 2018 with multiple components: (1) gatekeeping via tiered reimbursement, (2) a family physician scheme and (3) a two-way referral system between PHC facilities and hospitals. This study examines the reform impacts on health service utilisation, out-of-pocket expenditures, health outcomes and health inequalities.</p><p><strong>Methods: </strong>The staggered roll-out of the reforms in 125 cities across China was identified using web-scraping. Using longitudinal data (2011-2018) from the China Health and Retirement Longitudinal Study (a cohort aged ≥45), this study adopted a difference-in-differences method to assess the reform's impacts on: (1) visits to PHC facilities, (2) hospitalisation, (3) out-of-pocket expenditures (OOPEs) and (4) self-reported health. Subgroup analyses were conducted by rural/urban populations and wealth quartiles.</p><p><strong>Results: </strong>The reform had small and short-lived impacts-a 7.8% increase in the probability of visiting PHC facilities (95% CI 0.3 to 15.2), a 10.2% increase in reporting good health (95% CI 0.6 to 19.8) and an 873.9 Chinese Yuan (US$129.1) increase in average annual OOPEs (95% CI 57.9 to 1689.9) in the first year of reform implementation. There was no impact on hospitalisation. Increases in PHC utilisation were only found in rural and lower-income populations.</p><p><strong>Conclusions: </strong>China's PHC reforms had some modest, temporary impacts on increasing primary care utilisation and self-reported health. However, further interventions are needed to transition away from the hospital-centric health system and to increase financial protection and health equity in China.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 1","pages":"e001595"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}