Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.

Cancer burden in China:trends,risk factors and prevention

As the most populous country in the world,China has made strides in health promotion in the past few decades.With the aging population,the burden of cancer in China continues to grow.Changes in risk factors for cancer,especially diet,obesity,diabetes,and air pollution,continue to fuel the shift of cancer transition in China.The burden of upper gastrointestinal cancer in China is decreasing,but still heavy.The rising burden of colorectal,prostate,and breast cancers is also significant.Lung cancer became the top cause of cancer-related deaths,together with smoking as the most important contributor to cancer deaths.The Chinese government has taken several approaches to control cancer and cancer-related risk factors.Many achievements have been made,but some challenges remain.Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China.The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments,public health organizations,and individuals.In this review,we describe the trends of cancer burden and discuss cancer-related risk factors in China,identifying strategies to reduce the burden of cancer in China.

Self-perceived burden and influencing factors in patients with cervical cancer administered with radiotherapy

BACKGROUND Cervical cancer is the fourth commonest malignancy in women around the world.It represents the second most commonly diagnosed cancer in South East Asian women,and an important cancer death cause in women of developing nations.Data collected in 2018 revealed 5690000 cervical cancer cases worldwide,85%of which occurred in developing countries.AIM To assess self-perceived burden(SPB)and related influencing factors in cervical cancer patients undergoing radiotherapy.METHODS Patients were prospectively included by convenient sampling at The Fifth Affiliated Hospital of Sun Yat-Sen University,China between March 2018 and March 2019.The survey was completed using a self-designed general information questionnaire,the SPB scale for cancer patients,and the self-care self-efficacy scale,Strategies Used by People to Promote Health,which were delivered to patients with cervical cancer undergoing radiotherapy.Measurement data are expressed as the mean±SD.Enumeration data are expressed as frequencies or percentages.Caregivers were the spouse,offspring,and other in 46.4,40.9,and 12.7%,respectively,and the majority were male(59.1%).As for pathological type,90 and 20 cases had squamous and adenocarcinoma/adenosquamous carcinomas,respectively.Stage IV disease was found in 12(10.9%)patients.RESULTS A total of 115 questionnaires were released,and five patients were excluded for too long evaluation time(n=2)and the inability to confirm the questionnaire contents(n=3).Finally,a total of 110 questionnaires were collected.They were aged 31-79 years,with the 40-59 age group being most represented(65.4%of all cases).Most patients were married(91.8%)and an overwhelming number had no religion(92.7%).Total SPB score was 43.13±16.65.SPB was associated with the place of residence,monthly family income,payment method,transfer status,the presence of radiotherapy complications,and the presence of pain(P<0.05).The SPB and self-care self-efficacy were negatively correlated(P<0.01).In multivariate analysis,self-care self-efficacy,place of residence,monthly family income,payment method,degree of radiation dermatitis,and radiation proctitis were influencing factors of SPB(P<0.05).CONCLUSION Patients with cervical cancer undergoing radiotherapy often have SPB.Self-care self-efficacy scale,place of residence,monthly family income,payment method,and radiation dermatitis and proctitis are factors independently influencing SPB.

Economic burden and influencing factor analysis of outpatients with epilepsy: A cross-sectional study in Shanghai,Shanxi and Sichuan

Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional study. Methods: Using a self-designed questionnaire, we collected information retrospectively from 754 patients with epilepsy evaluated in neurology clinics in Shanghai Municipality, Shanxi Province and Sichuan Province. Descriptive analyses were used after cost variables were presented as logarithms, and multiple linear regressions were performed to explore influencing factors. Results: Fifty percent of the investigated patients experienced an epilepsy attack before the age of 15, and 51.3% had suffered from epilepsy for more than five years. In the past year, 87.9% of patients had visited different hospitals multiple times for evaluation(40.3%) and maintenance treatment(40.7%). The total economic burden of epilepsy was US$ 1143.2. The average direct economic burden and indirect economic burden were US$ 939.0 and US$ 110.2, respectively. Multiple linear regressions showed that patients had to bear greater economic burden if they were hospitalized,using multiple antiepileptic drugs, experiencing illness for less than 5 years, in severe seizure index or active epilepsy with drug resistance, which was statistically significant. Totally only14.3% of patients could get reimbursement in outpatient services. Conclusions: Patients with epilepsy must present to hospitals regularly for satisfactory prognosis, which results in economic burden. Patients bear greater economic burden, especially direct medical costs, if they are newly diagnosed, experience severe seizures, or undergo multiple drug treatments that require more frequent monitoring. However, current insurance policy for outpatient services do not help reduce economic burden of patients efficiently.

Global and Regional Trends and Projections of Infective Endocarditis-Associated Disease Burden and Attributable Risk Factors from 1990 to 2030

Objective To forecast the future burden and its attributable risk factors of infective endocarditis(IE).Methods We analyzed the disease burden of IE and its risk factors from 1990 to 2019 using the Global Burden of Disease 2019 database and projected the disease burden from 2020 to 2030 using a Bayesian age-period-cohort model.Results By 2030,the incidence of IE will increase uncontrollably on a global scale,with developed countries having the largest number of cases and developing countries experiencing the fastest growth.The affected population will be predominantly males,but the gender gap will narrow.The elderly in high-income countries will bear the greatest burden,with a gradual shift to middle-income countries.The incidence of IE in countries with middle/high-middle social-demographic indicators(SDI) will surpass that of high SDI countries.In China,the incidence rate and the number of IE will reach 18.07 per 100,000 and 451,596 in 2030,respectively.IEassociated deaths and heart failure will continue to impose a significant burden on society,the burden on women will increase and surpass that on men,and the elderly in high-SDI countries will bear the heaviest burden.High systolic blood pressure has become the primary risk factor for IE-related death.Conclusions This study provides comprehensive analyses of the disease burden and risk factors of IE worldwide over the next decade.The IE-associated incidence will increase in the future and the death and heart failure burden will not be appropriately controlled.Gender,age,regional,and country heterogeneity should be taken seriously to facilitate in making effective strategies for lowering the IE disease burden.

Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries

BACKGROUND Colorectal cancer(CRC)plays a significant role in morbidity,mortality,and economic cost in the Belt and Road Initiative(“B and R”)countries.In addition,these countries have a substantial consumption of processed meat.However,the burden and trend of CRC in relation to the consumption of a diet high in processed meat(DHPM-CRC)in these“B and R”countries remain unknown.AIM To analyze the burden and trend of DHPM-CRC in the“B and R”countries from 1990 to 2019.METHODS We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC.Numbers and age-standardized rates(ASRs)of deaths along with the disability-adjusted life years(DALYs)were determined among the“B and R”countries in 1990 and 2019.Using joinpoint regression analysis,the average annual percent change(AAPC)was used to analyze the temporal trends of age-standardized DALYs rate(ASDALR)from 1990 to 2019 and in the final decade(2010–2019).RESULTS We found geographical differences in the burden of DHPM-CRC among“B and R”countries,with the three highest-ranking countries being the Russian Federation,China,and Ukraine in 1990,and China,the Russian Federation,and Poland in 2019.The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019(all P<0.05).The absolute number of deaths and DALYs in DHPM-CRC were 3151.15[95%uncertainty interval(UI)665.74-5696.64]and 83249.31(95%UI 15628.64-151956.31)in China in 2019.However,the number of deaths(2627.57-2528.51)and DALYs(65867.39-55378.65)for DHPM-CRC in the Russian Federation has declined.The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam,Southeast Asia,with an AAPC value of 3.90%[95%confidence interval(CI):3.63%-4.16%],whereas the fastest decline was observed in Kyrgyzstan,Central Asia,with an AAPC value of-2.05%(95%CI:-2.37%to-1.73%).A substantial upward trend in ASR of mortality,years lived with disability,years of life lost,and DALYs from DHPM-CRC changes in 1990-2019 and the final decade(2010-2019)for most Maritime Silk Route members in East Asia,South Asia,Southeast Asia,North Africa,and the Middle East,as well as Central Europe,while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly(all P<0.05).The ASDALR for DHPM-CRC increased more in males than in females(all P<0.05).For those aged 50-74 years,the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend,except for 20 members,including 7 members in Central Asia,Maldives,and 12 high or high-middle social development index(SDI)members in other regions(all P<0.05).CONCLUSION The burden of DHPM-CRC varies substantially across“B and R”countries and threatens public health.Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in“B and R”countries via extensive collaboration.

Trend Analysis of the Burden of Hypertensive Heart Disease in China from 1990 to 2021

Objective:To quantitatively analyze the burden of hypertensive heart disease(HHD)in China and provide a scientific basis for prevention and control strategies.Methods:Data from the Global Burden of Disease 2021 database were used to assess the disease burden,deaths,years lived with disability(YLDs),and risk factors for HHD in the Chinese population from 1990 to 2021.Results:From 1990 to 2021,HHD cases in China increased from 1.5 million to 3.9 million,with an average annual growth rate of 2.83%.Prevalence rose from 127.76/100,000 to 259.00/100,000,while age-standardized prevalence decreased by 0.68%annually.HHD deaths increased from 232,478 to 320,247,with a mortality rate rise from 19.76/100,000 to 22.56/100,000,though age-standardized mortality decreased by 2.68%annually.YLDs rose from 124,386 to 301,426,with the rate increasing by 2.20%annually,while age-standardized YLDs decreased by 0.67%annually.High sodium intake and low fruit consumption were key risk factors for HHD deaths.Deaths related to low vegetable intake decreased until 2005 and then rose,while deaths from lead exposure showed a similar pattern.Conclusion:HHD cases and prevalence increased significantly,but age-standardized prevalence and mortality rates declined,reflecting the impact of an aging population and improved health interventions.The rise in YLDs highlights the long-term impact on patients’quality of life.Key risk factors included high sodium intake and low fruit consumption,emphasizing the importance of dietary improvements in HHD prevention.HHD remains a significant public health challenge in China,requiring continuous research and targeted prevention strategies.

1990—2021年中国归因于饮食因素的缺血性心脏病疾病负担变化趋势及预测研究

背景缺血性心脏病(IHD)是导致中国居民疾病负担的第二大原因,饮食因素干预被认为是减少疾病负担有效及可行的措施。目的分析1990—2021年中国归因于饮食因素的IHD疾病负担变化及未来变化趋势,以期为中国IHD的饮食防治提供参考。方法提取2021年全球疾病负担(GBD 2021)数据库中1990—2021年中国、全球、不同社会人口指数(SDI)地区的归因于饮食因素的IHD疾病负担相关数据,应用Joinpoint模型计算年度变化百分比(APC)及平均年度变化百分比(AAPC),分析1990—2021年中国、全球、不同SDI地区归因于饮食因素的IHD疾病负担,中国不同性别、年龄人群归因于饮食因素的IHD疾病负担以及归因于不同类型饮食因素的IHD疾病负担。利用贝叶斯年龄时期队列(BAPC)模型预测2022—2031年中国归因于饮食因素的IHD标化死亡率、标化伤残调整寿命年(DALY)率变化趋势。结果2021年中国归因于饮食因素的IHD标化死亡率为44.26/10万、标化DALY率为820.87/10万,与全球水平接近,高于高SDI地区,低于其余4类SDI地区。1990—2021年中国归因于饮食因素的IHD标化死亡率(AAPC=-0.17%,P<0.001)、标化DALY率(AAPC=-0.50%,P<0.001)与全球及五类SDI地区一致,均呈现下降趋势,全球下降幅度明显高于中国,高SDI地区下降速度最快。1990年与2021年中国男性归因于饮食因素的IHD疾病负担均高于女性;1990—2021年中国男性归因于饮食因素的IHD标化死亡率(AAPC=0.25%,P<0.001)呈上升趋势,女性标化死亡率(AAPC=-0.71%,P<0.001)、标化DALY率(AAPC=-1.23%,P<0.001)均呈下降趋势。1990与2021年中国归因于饮食因素的IHD疾病负担随着年龄增长呈上升趋势,≥70岁人群的死亡率、DALY率最高;1990—2021年50~69岁人群死亡率、DALY率呈下降趋势,而15~49岁、≥70岁人群呈上升趋势(P<0.001)。1990年与2021年归因于13种饮食因素的IHD标化死亡率、标化DALY率排名前两位的饮食因素均是钠摄入过量、全谷物摄入不足;1990—2021年标化死亡率、标化DALY率上升趋势较明显的是含糖饮料摄入过量、加工肉摄入过量、红肉摄入过量。BAPC模型显示,未来10年中国归因于饮食因素的IHD标化死亡率,标化DALY率均呈下降趋势。结论1990—2021年中国归因于饮食因素的IHD标化死亡率、标化DALY率均呈下降趋势,但下降速度与高SDI地区相比差距较大,男性和老年人群负担较重,因此仍需重视IHD的饮食防控策略,加强宣传健康的膳食模式,倡导增加全谷物的摄入,减少钠盐、含糖饮料、加工肉、红肉的摄入,采取针对性措施进行有效干预以减轻其疾病负担。

《中国心血管健康与疾病报告2023》要点解读

中国心血管病(CVD)患病率处于持续上升阶段。推算CVD现患人数3.3亿,其中卒中1300万,冠心病(CHD)1139万,心力衰竭(HF)890万,肺源性心脏病500万,心房颤动487万,风湿性心脏病250万,先天性心脏病200万,外周动脉疾病(PAD)4530万,高血压2.45亿。2021年中国心脑血管疾病患者出院总人次数为2764.98万,占同期出院总人次数(包括所有住院病种)的15.36%,其中CVD 1487.23万人次,占8.26%,脑血管病1277.75万人次,占7.10%。CVD给居民和社会带来的经济负担仍在加重,CVD防治的拐点尚未到来。

Current cancer burden in China: epidemiology, etiology, and prevention

Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.

Changing trends of disease burden of gastric cancer in China from 1990 to 2019 and its predictions:Findings from Global Burden of Disease Study

Objective:China is one of the countries with the heaviest burden of gastric cancer(GC)in the world.Understanding the epidemiological trends and patterns of GC in China can contribute to formulating effective prevention strategies.Methods:The data on incidence,mortality,and disability-adjusted life-years(DALYs)of GC in China from1990 to 2019 were obtained from the Global Burden of Disease Study(2019).The estimated annual percentage change(EAPC)was calculated to evaluate the temporal trends of disease burden of GC,and the package Nordpred in the R program was used to perform an age-period-cohort analysis to predict the numbers and rates of incidence and mortality in the next 25 years.Results:The number of incident cases of GC increased from 317.34 thousand in 1990 to 612.82 thousand in2019,while the age-standardized incidence rate(ASIR)of GC decreased from 37.56 per 100,000 in 1990 to 30.64 per 100,000 in 2019,with an EAPC of-0.41[95%confidence interval(95%CI):-0.77,-0.06].Pronounced temporal trends in mortality and DALYs of GC were observed.In the next 25 years,the numbers of new GC cases and deaths are expected to increase to 738.79 thousand and 454.80 thousand,respectively,while the rates of incidence and deaths should steadily decrease.The deaths and DALYs attributable to smoking were different for males and females.Conclusions:In China,despite the fact that the rates of GC have decreased during the past three decades,the numbers of new GC cases and deaths increased,and will continue to increase in the next 25 years.Additional strategies are needed to reduce the burden of GC,such as screening and early detection,novel treatments,and the prevention of risk factors.

Stomach cancer burden in China: Epidemiology and prevention

In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.

Trends and risk factors of lung cancer in China

China is faced with heavy burdens caused by lung cancer,which has climbed to the top of both cancer incidence and mortality spectrums.The age-standardized rates of incidence and mortality have shown a trend of gradual uptrends in the last decades,while the crude rates rise much quickly due to the aging of population.Although the improvement in health care has contributed to better survival of lung cancer,its prognosis is still challenging.Apart from the common risk factors such as tobacco use,air pollution,and occupational hazards,some specific factors like Chinese-style cooking also have posed great threats to human health.In light of such national conditions,specific interventions should be conducted to curb the burden of lung cancer including smoking cessation,improvement of air quality,early detection and effective treatment of lung cancer.

Prevalence and Predictors of Double Burden of Malnutrition within Households in Africa: A Systematic Review

In recent years, there has been growing interest in the emergence of double burden of malnutrition (DBM) in Africa. In this study, we reviewed the literature on double burden of malnutrition in households, reviewing previous studies investigating the prevalence of DBM in Africa and the factors associated with it. To identify relevant studies, we consulted the PubMed and Cochrane electronic databases, using specific search terms. A total of seventeen articles met the eligibility criteria. These articles were published between 2012 and 2022, and their data were collected between 2000 and 2019. Twelve of these studies used secondary data, including demographic and health surveys. The age of children and adults varied from study to study. All studies used Body Mass Index as a nutritional indicator for adults. For children, the height-for-age Z-score was most commonly used, while weight-for-age, weight-for-height and Body Mass Index-for-age were less commonly used. The national prevalence of double nutritional burden in households ranged from 1.71% to 38.7%, depending on the country and the year. However, direct comparisons between studies were limited due to differences in combinations of undernutrition, overweight or obesity. Among the factors associated with double nutritional burden within households, the most frequently cited in the selected articles were urban/rural residence, income or socioeconomic status, age of child and mother, household size and mother’s level of education. However, no study assessed physical activity, and very few examined the diet of household members. It is essential to take these different parameters into account when designing and implementing interventions to prevent the DBM in Africa. Community and societal factors will also need to be studied and taken into account in these interventions.

1990—2019年中国结直肠癌疾病负担变化趋势分析

目的 分析1990-2019年中国结直肠癌疾病负担变化趋势及定量估计影响因素。方法 利用2019年全球疾病负担研究结果,分析1990-2019年我国结直肠癌疾病负担以及危险因素归因疾病负担的变化情况,并采用Gupta分解法定量估算人口增长、老龄化、年龄别患病率和疾病严重程度的改变对疾病负担变化的贡献。结果 1990-2019年我国结直肠癌标化伤残调整寿命年率(DALY rates)呈上升趋势,2019年DALY值较1990年增长了191.12%,其中34.54%可归因于人口增长、111.36%可归因于人口老龄化、77.56%可归因于年龄别患病率的增加、-32.34%归因于疾病严重程度。牛奶摄入不足位列2019年结直肠癌的首要危险因素,其次是谷物摄入不足和钙摄入不足;11种可改变的危险因素中,高BMI所致标化DALY率较1990年增幅最大(225.15%),年均增长4.14%,纤维素摄入不足所致标化DALY率较1990年降幅最大(-44.23%),年均减少2.00%。结论 1990-2019年,我国结直肠癌疾病负担呈上升趋势,人口老龄化是导致结直肠癌疾病负担增长最主要的原因,卫生行政部门应采取相应措施应对老龄化带来的不利影响。

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication.AIM To investigate the economic burden,clinical characteristics,risk factors,and mechanisms of intracranial hemorrhage after spinal surgery.METHODS A retrospective cohort study was conducted from January 1,2015,to December 31,2022.Patients aged≥18 years,who had undergone spinal surgery were included.Intracranial hemorrhage patients were selected after spinal surgery during hospitalization.Based on the type of spinal surgery,patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage.The patients'pre-,intra-,and post-operative data and clinical manifestations were recorded.RESULTS A total of 24472 patients underwent spinal surgery.Six patients(3 males and 3 females,average age 71.3 years)developed intracranial hemorrhage after posterior spinal fusion procedures,with an incidence of 0.025%(6/24472).The prevailing type of intracranial hemorrhage was cerebellar hemorrhage.Two patients had a poor clinical outcome.Based on the type of surgery,30 control patients were randomly matched in 1:5 ratio.The intracranial hemorrhage group showed significant differences compared with the control group with regard to age(71.33±7.45 years vs 58.39±8.07 years,P=0.001),previous history of cerebrovascular disease(50%vs 6.7%,P=0.024),spinal dura mater injury(50%vs 3.3%,P=0.010),hospital expenses(RMB 242119.1±87610.0 vs RMB 96290.7±32029.9,P=0.009),and discharge activity daily living score(40.00±25.88 vs 75.40±18.29,P=0.019).CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low,with poor clinical outcomes.Patient age,previous stroke history,and dura mater damage were possible risk factors.It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

企业税负结构、税收成本粘性与全要素生产率

从税源的纳税人结构来看,我国税收收入主要源于企业,宏观层面的税制结构在微观领域主要投射为企业税负结构,税制结构对经济效率的宏观影响会通过企业税负结构对微观全要素生产率的促进或抑制来实现。因此,基于上市公司微观主体实证检验企业税负结构变化对微观全要素生产率的影响,可以验证税制结构对经济效率的宏观治理效应。研究结果表明:现行以间接税为主的企业税负结构对全要素生产率具有显著的抑制作用,具体表现为企业增值税负与企业所得税负比值越大,对全要素生产率抑制作用越强。进一步研究结果表明:企业税负结构是通过增加税收成本粘性对全要素生产率产生抑制作用;在当前税收立法水平与税制安排下,税收征管在企业税负结构抑制全要素生产率中发挥了正向调节作用。

广州市某医院脑梗死患者疾病经济负担研究

目的分析脑梗死患者次均住院费用,特别是次均住院自负费用的结构以及影响因素,为缓解患者疾病经济负担提供参考依据。方法运用描述性统计分析对广州市某三甲医院2015—2022年脑梗死出院患者的次均费用及费用结构进行比较分析,并采用多重线性分析法研究影响患者次均住院自负费用的因素。结果脑梗死患者次均住院费用增长放缓,年均增长率为2.86%;费用结构逐步优化,2022年次均技术劳务费占比47.41%;脑梗死患者次均住院自负费用呈增长趋势,年均增长率5.96%,且受住院时间、病例分型、付费方式以及患者来源等因素共同影响。结论脑梗死患者的疾病经济负担仍然较重,医疗机构应不断规范诊疗行为,加强临床路径管理,政府应该不断完善社会保障体系,降低患者的疾病经济负担。

脑深部电刺激术后帕金森病患者照顾者照顾负担的影响因素及生活质量研究

目的探讨照顾者照顾负担的影响因素及照顾负担与生活质量相关性,为脑深部电刺激术(DBS)后帕金森病患者主要照顾者照顾负担的预防干预提供依据。方法采取横断面研究设计,通过方便抽样法选取2022-01—2023-08南京医科大学附属脑科医院收治85例原发性帕金森病行DBS患者及与患者密切接触时间3个月及以上、年龄≥18岁家庭成员,术前3 d利用社会人口学基本信息调查表收集患者及照顾者基本信息,应用改良Hoehn-Yahr、国际运动障碍协会(MDS)改良统一帕金森病评价量表第Ⅰ、Ⅱ、Ⅲ部分、汉密尔顿焦虑抑郁量表、MMSE、PDQ39、蒙特利尔认知评估、神经精神科问卷(NPI)对患者进行调查,分析患者疾病状态。术前24 h,应用照顾者负担量表(ZBI)、照顾相关生活质量(CarerQol)量表对照顾者进行调查,通过Spearman等级相关分析,进行照顾者负担相关影响因素分析,探讨脑深部电刺激术后帕金森病患者照顾者负担影响因素及与生活质量相关性。结果患者片段化睡眠达69.4%,PDQ39平均(47.31±20.15),自理能力部分需要帮助72.9%,精神行为除妄想外余9条均与照顾者负担呈正相关(P<0.05)。照顾者ZBI得分(46.99±18.97),其中无负担占8.2%,轻度占29.4%,中度占32.9%,重度占29.4%。CarerQol-7D得分6.92±3.20,CarerQol-VAS得分4.84±2.34,且ZBI与CarerQol-7D除成就感外其他6项及总分均呈正相关,P<0.05。结论脑深部电刺激术后帕金森病患者照顾者普遍存在照顾负担,并影响其生活质量,影响因素较多,其中苦恼程度、情绪状态、生活自理程度、照顾者与患者亲密关系是照顾者负担重要独立影响因素,临床医务人员需重视并予以措施,以减轻这类人群照顾负担,提高其及患者生活质量。

妇科恶性肿瘤患者家庭照顾负荷现状调查及影响因素分析

目的:分析妇科恶性肿瘤患者家庭照顾负荷现状及影响因素。方法:采用便利抽样方法,选取2022年3月-2024年1月在本院就诊的妇科恶性肿瘤患者的照顾者进行问卷调查。使用照顾负荷问卷(CBI)评估照顾者照顾负荷水平,总分96分,0~32分为CBI较低组,33~96分为CBI较高组。采用单因素及logistic回归分析影响照顾者CBI评分可能影响因素。结果:共发放问卷297份,有效问卷290份,有效率97.6%。290例照顾者的CBI为60.36±5.55分,其中CBI≤32分110例(37.9%),≥33分180例(62.1%)。单因素及多元回归分析显示,照顾者年龄大、文化程度低、月收入低、居住在农村、每日照顾时间长、患者患病时间长、患者年住院次数多是妇科恶性肿瘤患者照顾者CBI评分升高影响因素(P<0.05)。结论:本次调查的妇科肿瘤患者CBI评分较高,照顾负荷相对较重,照顾者年龄大、文化程度低、月收入低、居住农村、每日照顾时间长,以及患者患病时间长、年住院次数多是影响照顾者CBI独立因素。提高恶性肿瘤患者社会及家庭支持,构建基于医院-社区-家庭三元联动的健康管理模式等将有助于缓解恶性肿瘤患者家庭照顾负荷,对恶性肿瘤患者的疾病治疗和康复有重要意义。