Frontiers in epidemiology最新文献

{"title":"Editorial: The MASLD spectrum: an emerging epidemic of cardiometabolic and extra-hepatic dimensions.","authors":"Akash Batta, Arka De, Omesh Goyal, Aalam Sohal","doi":"10.3389/fepid.2026.1893613","DOIUrl":"10.3389/fepid.2026.1893613","url":null,"abstract":"","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1893613"},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371129","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":"The persistence and mortality of Lassa fever in Nigeria reflect systemic clinical and diagnostic challenges rather than viral reemergence alone.","authors":"Opeyemi Hammed, Miracle Adesina, Busayo Buoye, Damilare Taiwo, Isaac Olufadewa, Dorcas Alabi","doi":"10.3389/fepid.2026.1837721","DOIUrl":"10.3389/fepid.2026.1837721","url":null,"abstract":"","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1837721"},"PeriodicalIF":2.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371091","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":"Modeling the disruptive impact of the COVID-19 pandemic on nurses' supply and wages.","authors":"Raffaele Vardavas, Pedro Nascimento De Lima, Lawrence Baker, Christina Crowley, Katherine Carman, Andrew M Parker, Mahshid Abir","doi":"10.3389/fepid.2026.1631582","DOIUrl":"10.3389/fepid.2026.1631582","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic severely disrupted hospital nurse labor supply and wage dynamics through deteriorating working conditions, heightened occupational stress, and epidemiological pressures, exacerbating pre-existing nursing shortages. Federal relief funds were allocated to mitigate staffing shortfalls, but their effects on healthcare labor markets remain poorly characterized.</p><p><strong>Methods: </strong>We developed a behavioral economic model using a system of coupled ordinary differential equations (ODEs) to simulate hospital nurses' supply and wage dynamics at the national aggregate level during the COVID-19 pandemic. Epidemiological time-series (COVID-19 cases, hospitalizations, deaths) were provided as exogenous inputs. A perceived pandemic work burden variable-modeled as an exponential weighted moving average (EWMA) of fatigue and mental anguish proxies-drives nurse supply through a sigmoid-shaped supply surface. Travel nurse substitution dynamics and hospital relief fund eligibility constraints are incorporated. The model was calibrated using 15,000 Latin Hypercube Sampling prior runs and an Incremental Mixture Approximate Bayesian Computation (IMABC) procedure, converging to 500 posterior accepted runs.</p><p><strong>Results: </strong>The calibrated model reproduces observed dynamics for staff and travel nurse workforce participation and wages during the pandemic. Scenario analyses contrasting constrained and unconstrained hospital spending on travel nurses (governed by the parameter λ _<i>C</i> ) reveal a fundamental tension in relief fund design: unrestricted reimbursement reduces immediate staffing gaps but incentivizes excessive reliance on contract labor, while overly stringent requirements deter legitimate fund applications, particularly from rural and safety-net hospitals.</p><p><strong>Discussion: </strong>This conceptual model demonstrates that it is feasible to jointly simulate epidemiological dynamics and nurse labor market responses in a unified ODE framework. The model provides a foundation for investigating the effectiveness of pandemic relief programs and informing staffing policy for future public health emergencies, and is well-suited for embedding within robust decision-making frameworks.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1631582"},"PeriodicalIF":2.9,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13303850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347600","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":"HIV-1 late diagnosis in Cabo Verde: associated factors and implications for preventive strategies.","authors":"Silvânia da Veiga Leal, Mafalda N S Miranda, Ricardo Parreira, Victor Pimentel, Isabel Inês Monteiro de Pina Araújo, Marta Pingarilho, Ana B Abecasis","doi":"10.3389/fepid.2026.1861884","DOIUrl":"10.3389/fepid.2026.1861884","url":null,"abstract":"<p><strong>Background: </strong>Late diagnosis of HIV infection remains a major public health challenge, associated with higher morbidity and mortality, ongoing transmission, opportunistic infections, and higher healthcare costs. Despite free access to HIV-1 testing and antiretroviral therapy in Cabo Verde, the prevalence and determinants of late HIV diagnosis remain poorly characterised. Therefore, this study aimed to assess the prevalence of late HIV diagnosis and identify associated factors among newly diagnosed, treatment-naïve individuals with HIV-1 in Cabo Verde.</p><p><strong>Methods: </strong>A cross-sectional study combining interview - based data with retrospective extraction of clinical data was conducted among 135 newly diagnosed, treatment - naïve individuals between 2018 and 2019 across four islands of Santiago, Fogo, São Vicente, and Boavista. Late HIV diagnosis was defined as CD4+ < 350 cells/µL at diagnosis or the presence of an AIDS-defining condition. Sociodemographic and clinical data were collected, and viral genetic diversity was assessed through nucleotide ambiguity analysis. Associations with late HIV diagnosis were evaluated using univariable and multivariable logistic regression, presented as odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Overall, 56.3% (76/135) of individuals were classified as having late HIV diagnosis. In multivariable analysis, being single (aOR: 2.79; 95% CI: 1.13-6.92; <i>p</i> = 0.027) and having viral load ≥5.0 log copies/mL (aOR: 5.24; 95% CI: 1.80-15.25; <i>p</i> = 0.002) were independently associated with late HIV diagnosis. Genetic ambiguity analysis showed a predominance of recent infections (68.3%), with low concordance with CD4+ T-cell counts.</p><p><strong>Conclusions: </strong>HIV-1 late diagnosis remains highly prevalent in Cabo Verde and is associated with single marital status and higher viral load. These findings highlight persistent gaps in early HIV testing and timely linkage to care. Strengthening targeted testing strategies is essential to improve clinical outcomes and reduce HIV transmission, in line with the UNAIDS 95-95-95 targets.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1861884"},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347594","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":"Incidence, prevalence, and prognostic impact of sarcopenia on hepatic and cardiovascular outcomes in non-cirrhotic metabolic dysfunction-associated steatotic liver disease.","authors":"Rishi Chowdhary, Manjeet Kumar Goyal, Megh Patel, Rahul Chowdhary, Kirti Arora, Varun Mehta, Akash Batta, Omesh Goyal, Ashita Rukmini Vuthaluru","doi":"10.3389/fepid.2026.1779600","DOIUrl":"10.3389/fepid.2026.1779600","url":null,"abstract":"<p><strong>Background and aim: </strong>Sarcopenia is increasingly recognized as a clinically relevant comorbidity in metabolic dysfunction-associated steatotic liver disease (MASLD), yet its epidemiology and prognostic implications in non-cirrhotic disease remain incompletely characterized. We aimed to evaluate temporal trends in the incidence and prevalence of sarcopenia among patients with MASLD and to assess its association with hepatic and cardiovascular outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal cohort study of adults with MASLD diagnosed between 2005 and 2024 using a large, nationwide electronic health record network. Annual incidence and prevalence of sarcopenia were examined over time. Non-cirrhotic MASLD patients with sarcopenia were compared with non-sarcopenic controls using 1:1 propensity score matching to balance demographic characteristics, metabolic comorbidities, cardiovascular risk factors, and medication use. Hepatic and cardiovascular outcomes were evaluated using Kaplan-Meier analyses and Cox proportional hazards models.</p><p><strong>Results: </strong>Among 1,232,337 patients with MASLD, 714 had documented sarcopenia. Both incidence and prevalence of sarcopenia increased steadily over the study period, with comparable trends across sexes. After propensity score matching, sarcopenia was associated with significantly higher odds of cirrhosis (OR 4.46), hepatic decompensation (OR 5.18), and all-cause mortality (OR 2.36). Sarcopenic MASLD patients also demonstrated increased risk of major adverse cardiovascular events, including heart failure, ischemic heart disease, atrial fibrillation, cerebrovascular events, and thrombotic disorders. On time-to-event analysis, sarcopenia independently predicted hepatic outcomes (HR 5.03) and cardiovascular outcomes (HR 2.24).</p><p><strong>Conclusion: </strong>Sarcopenia is an increasingly prevalent condition in MASLD and a powerful independent predictor of adverse hepatic and cardiovascular outcomes in non-cirrhotic disease. These findings underscore the importance of early identification and targeted management of sarcopenia to improve long-term outcomes in MASLD.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1779600"},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347592","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":"When seasonal structure dominates: rethinking causal attribution in environmental epidemiology.","authors":"Erling Häggström Gunfridsson","doi":"10.3389/fepid.2026.1880350","DOIUrl":"10.3389/fepid.2026.1880350","url":null,"abstract":"<p><p>Reproducibility is widely treated as evidence of reliable causal inference in environmental epidemiology. Yet in environmental time-series studies, exposures, behaviours, and mortality often share strong seasonal structure, making causal inference highly dependent on modelling assumptions. Temperature, air pollution, and mortality co-vary systematically across the calendar year, creating tightly coupled temporal patterns that limit empirical separability between competing explanations. In such settings, reproducible associations may partly reflect shared analytical conventions for representing seasonality rather than uniquely identifiable causal effects. Using daily mortality data from Stockholm, Sweden, we show that estimated associations for temperature and nitrogen dioxide (NO₂) vary substantially across alternative specifications of seasonal adjustment, even when all other model components are held constant. Estimated effects attenuate or shift as progressively stronger seasonal controls are introduced, indicating that models redistribute overlapping seasonal variation between correlated predictors. These findings suggest that the central challenge is not simply confounding, but limited identifiability within highly correlated seasonal systems. Reproducibility should therefore be treated as a starting point for inference rather than definitive evidence of causal isolation. Greater transparency regarding modelling choices and sensitivity to seasonal specification is essential for responsible interpretation of environmental epidemiological evidence.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1880350"},"PeriodicalIF":2.9,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297250","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":"Ventilator-associated pneumonia among intensive care nurses: a multicenter cross-sectional study on knowledge and preventive measures in intensive care units of Mogadishu, Somalia.","authors":"Abdukadir Mohamed Hassan, Abdiwali Mohamed Hussein, Fathi Yasin Yusuf, Abdishakur Mohamud Hassan, Amal Abdullahi Abdi","doi":"10.3389/fepid.2026.1770279","DOIUrl":"10.3389/fepid.2026.1770279","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) remains a major healthcare-associated infection in intensive care units (ICUs), and its prevention largely depends on nurses' knowledge, attitudes, and adherence to recommended practices. Assessing these factors is essential for improving patient safety and the quality of ICU care. This study assessed the knowledge, attitudes, and preventive practices regarding VAP among ICU nurses in Mogadishu, Somalia.</p><p><strong>Methods: </strong>A multicenter descriptive cross-sectional study was conducted among 122 ICU nurses from five purposively selected hospitals in Mogadishu. Data were collected using a structured, validated self-administered questionnaire assessing socio-demographic characteristics, VAP-related knowledge, attitudes, and preventive practices. Descriptive statistics and Chi-square tests were performed using SPSS version 23, with statistical significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Most participants were aged 20-30 years (54.1%), male (52.5%), held a bachelor's degree (69.7%), and had received VAP training (73.8%). Overall, 85.2% of nurses demonstrated moderate knowledge, while 14.8% had good knowledge. Preventive measures such as hand hygiene (95.1%), sterile glove use (87.7%), and head-of-bed elevation (78.7%) were widely recognized. However, attitudes were predominantly poor, with 73.8% scoring below 50%, despite high recognition of oral care importance (83.6%). Preventive practices were also suboptimal, with 67.2% demonstrating poor practice levels. Although hand hygiene (73.8%) and glove use (69.7%) were commonly performed, only 50.8% consistently maintained the recommended semi-recumbent position. Significant associations were observed between socio-demographic characteristics and knowledge, attitudes, and practices (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>ICU nurses demonstrated moderate knowledge but poor attitudes and preventive practices regarding VAP prevention. Structured training, standardized protocols, and institutional support are needed to improve compliance and enhance patient safety.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1770279"},"PeriodicalIF":2.9,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297260","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":"Understanding the problem of chronic kidney disease in the Republic of Kazakhstan: the study on prevalence and patients' health behaviors.","authors":"Yerlan Burkutov, Yernur Zikiriya, Olzhas Zhandossov, Dinara Makhanbetkulova","doi":"10.3389/fepid.2026.1685648","DOIUrl":"10.3389/fepid.2026.1685648","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of epidemiological data on the prevalence of chronic kidney disease (CKD) and hemodialysis, as well as associated health behaviors in Central Asia, although this information is needed for the management of healthcare services. Therefore, this study was undertaken to analyze the prevalence of CKD and hemodialysis in the population of selected provinces of Kazakhstan over the period from 2017 to 2019. In addition, we investigated health literacy and self-management of patients with CKD.</p><p><strong>Methods: </strong>This study had a two-stage design. The first stage was a retrospective cross-sectional study, which relied on the data obtained from the electronic database maintained by the Republican Center for Health Development. Point and period prevalence of CKD and hemodialysis were calculated per million population (PMP). The second stage had a prospective cross-sectional design and involved 79 CKD patients presenting at a single nephrology center.</p><p><strong>Results: </strong>The point prevalence of CKD was the highest in 2017 ranging from 137.0 PMP in North Kazakhstan province to 388.8 PMP in Turkestan province. The point prevalence of hemodialysis was higher than that of CKD and ranged from 359.3 PMP (East Kazakhstan province, 2017) to 629.3 PMP (Kostanay province, 2018). There was a growth in the point prevalence of hemodialysis over the period of 3 years in all provinces, apart from Kostanay. CKD patients had suboptimal knowledge of their disease and less than adequate self-management skills with certain gender-specific differences.</p><p><strong>Conclusion: </strong>Additional studies are required to address the knowledge gap concerning determinants of CKD in the population of Kazakhstan.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1685648"},"PeriodicalIF":2.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280153","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":"In-hospital cardiovascular outcomes of COVID-19-associated cytokine storm: a population-level study.","authors":"Rajveer Sagoo, Navraj S Sagoo, Paul Murdock, Mohanakrishnan Sathyamoorthy","doi":"10.3389/fepid.2026.1836720","DOIUrl":"10.3389/fepid.2026.1836720","url":null,"abstract":"<p><strong>Background: </strong>In severe COVID-19, hyperinflammatory \"Cytokine Storm\" (CS) can escalate disease severity, yet large-scale data on its cardiovascular impacts remain limited.</p><p><strong>Objective: </strong>To assess the influence of CS severity on in-hospital cardiovascular outcomes and mortality in COVID-19 patients.</p><p><strong>Methods: </strong>A retrospective analysis of the 2021 National Inpatient Sample (NIS) was performed, including adults (≥18 years) hospitalized with a principal COVID-19 diagnosis (ICD-10: U07.1), while excluding other hyperinflammatory conditions. CS was identified and categorized into four severity grades (ICD-10: D89.83). Multivariable logistic regression was utilized to assess associations between CS severity and in-hospital outcomes.</p><p><strong>Results: </strong>In a weighted cohort of 1,428,892 hospitalized adults with COVID-19, 15,290 (1.1%) had CS. Mortality rose from 8.3% in non-CS patients to 26.9% in grade 4 (adjusted odds ratio [aOR] 3.334; 95% CI [2.810-3.956]), accompanied by increases in cardiac arrest (1.7%-4.4%; aOR 1.742; [1.234-2.459]) and venous thromboembolism (4.8%-9.4%; aOR 1.739; [1.369-2.210]) (<i>p</i> _all < 0.05). Myocardial Infarction (non-CS: 3.3% vs. Grade 4: 3.1%) and Cardiac Arrhythmias (non-CS: 14.4% vs. grade 4: 14.4%) remained similar across groups but showed decreased adjusted odds in grade 2 (aOR 0.328 [0.221-0.488]; aOR 0.738 [0.641-0.850]) (<i>p</i> _all < 0.05). Heart failure incidence declined with advancing CS grade (non-CS: 13.5% vs. grade 4: 12.5%), with grades 1 and 2 showing reduced odds (aOR 0.651; [0.475-0.892]), (aOR 0.702; [0.584-0.845]) (<i>p</i> _all < 0.05). Cardiogenic shock, Ischemic CVA, and Transient Ischemic attack were infrequent and excluded from graded analyses. Compared with non-CS patients, those with grade 4 had a longer median length of stay (5 days vs. 11 days) and higher median total cost (US $44,363 vs. US $142,280) (<i>p</i> _all < 0.05).</p><p><strong>Conclusion: </strong>Within this cohort, advanced CS demonstrated an association with increased mortality and select cardiovascular complications in hospitalized COVID-19 patients; Moreover, certain events, such as arrhythmias and heart failure, showed nuanced patterns, underscoring the complex interplay between hyperinflammation and cardiac pathophysiology.</p>","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1836720"},"PeriodicalIF":2.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280225","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":"From coverage to care: how basic medical insurance shapes patients' experiences of primary care in China.","authors":"Chufeng Xu, Wenhu Xu, Jiamin You, Gong Chen, Shuhan Miao","doi":"10.3389/fepid.2026.1785586","DOIUrl":"10.3389/fepid.2026.1785586","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;With the intensifying trend of population aging in China, the number of middle-aged and older adults continues to rise, and their demand for medical services is also increasing. Middle-aged and older adults can benefit from the convenience and protection provided by the hierarchical diagnosis and treatment system through medical insurance policies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study draws on Andersen's health service utilization model to examine how basic medical insurance shapes healthcare experiences among middle-aged and older adults with a primary-care orientation under China's hierarchical diagnosis and treatment system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study merges data from the 2016 and 2018 Chinese Family Panel Studies (CFPS) to create a balanced panel, with a total sample size of 6,114. This study uses fixed-effects models and panel ordered Logit models to examine the association between basic health insurance and satisfaction with healthcare facility conditions and healthcare service levels. Additionally, propensity score matching was used within the primary-care-oriented sample to improve comparability between insured and uninsured respondents, followed by fixed-effects estimation as a robustness check.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Descriptive analysis shows that, compared with 2016, the medical expenditure rate in 2018 decreased by 1.16%, while the hospitalization rate and the proportion of doctor visits increased modestly. The two-way fixed-effects results suggest that basic health insurance is positively associated with satisfaction with healthcare facility conditions, corresponding to an average within-person increase of 0.112 points on the observed 1-5 evaluation scale. By contrast, no statistically significant association is found between basic health insurance and healthcare service level. The ordered-model results and the PSM-based robustness checks are broadly consistent with the benchmark estimates. In addition, the strength of the association varies across subgroups defined by health status, age, gender, region, and household registration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Basic health insurance is associated with more favorable evaluations of healthcare facility conditions among middle-aged and older adults with a primary-care orientation, whereas its association with healthcare service level is not statistically robust. These findings suggest that the relationship between insurance coverage and patient-reported primary care experience may differ across dimensions of healthcare evaluation and across population subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contributions: &lt;/strong&gt;This study has important practical significance for promoting the hierarchical diagnosis and treatment system, optimizing the allocation of medical resources, and alleviating the problem of medical order. Through in-depth research and exploration of relevant issues, it can provide useful references for policy makers an","PeriodicalId":73083,"journal":{"name":"Frontiers in epidemiology","volume":"6 ","pages":"1785586"},"PeriodicalIF":2.9,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274011","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}