OBJECTIVES: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. METHODS: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R2) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. RESULTS: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). CONCLUSIONS: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.
Cities ; Health Expenditures/*statistics & numerical data/trends ; Humans ; Regression Analysis ; Republic of Korea

OBJECTIVETo study the relation between temperature and mortality by estimating the temperature-related mortality in Beijing, Shanghai, and Guangzhou.

METHODSData of daily mortality, weather and air pollution in the three cities were collected. A distributed lag nonlinear model was established and used in analyzing the effects of temperature on mortality. Current and future net temperature-related mortality was estimated.

RESULTSThe association between temperature and mortality was J-shaped, with an increased death risk of both hot and cold temperature in these cities. The effects of cold temperature on health lasted longer than those of hot temperature. The projected temperature-related mortality increased with the decreased cold-related mortality. The mortality was higher in Guangzhou than in Beijing and Shanghai.

CONCLUSIONThe impact of temperature on health varies in the 3 cities of China, which may have implications for climate policy making in China.

China ; Cities ; Climate Change ; Environmental Monitoring ; statistics & numerical data ; Humans ; Mortality ; Temperature ; Urban Population ; statistics & numerical data

Reproductive health (RH) education and services of female migrants in China have become an important health issue. This research aimed to investigate the RH knowledge and utilization among married female migrants, and to explore the influencing factors from the perspectives of population and sociology. We conducted a cross-section survey in Shenzhen and Wuhan, China, using the purposive sampling method. A total of 1021 rural-to-urban married migrants were recruited, with 997 valid survey results obtained. A face-to-face structured questionnaire survey was used, with primary focus on knowledge of fertility, contraception, family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome (STD/AIDs), and RH service utilization. The results showed that the RH service utilization (38.0%) was at a low level in married migrants and the accessibility of RH service was poor. Females who migrated to (OR=0.32) Wuhan obtained fewer RH consultations than those in Shenzhen. The workers with high school education received additional RH consultations and checkup services than those with other background education, apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers (P<0.05). We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China. RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.
Adolescent ; Adult ; China ; Cities ; statistics & numerical data ; Female ; Humans ; Population Dynamics ; Reproductive Health Services ; utilization ; Socioeconomic Factors ; Spouses ; statistics & numerical data ; Transients and Migrants ; statistics & numerical data

Childhood risky behaviors always result in adverse health outcomes. These behaviors are greatly affected by social environment and individual factors. However, few studies explored the social determinants of schoolchildren's health behaviors. In this cross-sectional study, the social determinants of health behaviors were examined among both migrant and resident students in Beijing, China. Data of 967 children from six urban and suburban primary schools were analyzed using multiple linear regression analysis. The results showed that less than 60% of children performed some healthy behaviors, although their health knowledge was generally good. Children's health behavior scores were greatly determined by school characteristics, health knowledge, demographic characteristics, and family context. Therefore, improving health education and conditions in primary schools is the priority to promote children's healthy behaviors, especially for disadvantaged children.
Adolescent ; Child ; China ; Cities ; statistics & numerical data ; Female ; Health Behavior ; Humans ; Male ; Schools ; statistics & numerical data ; Socioeconomic Factors ; Transients and Migrants ; statistics & numerical data

OBJECTIVEIn China, the coverage rate of work injury insurance was 23.2%in 2011, which was far lower than expected. The factors affecting the insurance's enrollment has very little known. This paper aims to study the existing coverage of work injury insurance scheme and its influencing factors.

METHODSThe data were collected from 2 836 workers who came from 9 industries in three cities of Zhejiang province using face-to-face questionnaire interview.

RESULTSOf these 2836 workers, the work injury insurance coverage was 50.1%, and 29.6% were not sure if they were covered or not. The results showed that the awareness of occupational disease and industrial injury insurance was helpful in increasing the coverage rate. Besides, the logistic regression analysis showed that in certain circumstances working population shared higher coverage of work injury insurance. For examples, male workers with local household registration and longer working years; people who had been informed about occupational risk factors, and thus gained more training on the issue; people who had exposed to occupational hazards or involved in administrative duties; and people who had already insured by a medical insurance scheme. In the contrary, the heavier family burden with longer working hours per week they needed, the lower possibility they joined the insurance scheme.

CONCLUSIONSThe coverage of work injury insurance is higher than native average level but much lower than the average international level. The awareness of occupational disease and injury insurance was closely associated with the coverage of work injury insurance. Therefore, it is imperative to popularize the knowledge on OHS for migrant workers, as well as to reinforce the supervision and management of the issue would have been an effective way to elevate the coverage rate of work injury insurance.

China ; Cities ; Health Services Needs and Demand ; Humans ; Insurance Coverage ; statistics & numerical data ; Male ; Occupational Diseases ; Surveys and Questionnaires ; Transients and Migrants

Tightening of air quality standards for populated urban areas has led to increasing attention to assessment of air quality management areas, where violation of air quality standards occurs, and development of control strategies to eliminate such violation of air quality standards. The Quetta urban area is very densely built and has heavy motorized traffic. The increase of emissions mainly from traffic and industry are responsible for the increase in atmospheric pollution levels during the last years. The dust examined in the current study was collected by both deposit gauge and Petri dish methods at various sites of Quetta Valley. Smoke particles were obtained by bladder method from the exhausts of various types of motor vehicles. The concentration of lead found in the smoke ranged from 1.5x10(-6) to 4.5x10(-6).
Air Pollution ; analysis ; Cities ; statistics & numerical data ; Dust ; analysis ; Environmental Monitoring ; methods ; Pakistan ; Particle Size ; Smoke ; analysis ; Vehicle Emissions ; analysis

Objective: To analyze the epidemiological characteristics of waist circumference and abdominal obesity among Chinese children and adolescents aged 6-17 years. Methods: Data was from the samples of aged 6-17 years in the China National Nutrition and Health Surveillance program in 2010-2012. P(90) (the same age, the same sex) was used as the diagnostic value for abdominal obesity. Results: The overall waist circumference of children and adolescents in all the age groups appeared higher in males than that in females (P<0.000 1), higher in cities than that in the rural areas (P<0.05), and higher in children with high family income than those with middle or low family incomes (P=0.000 3). The rate of abdominal obesity in children and adolescents aged 6-17 years appeared as 11.2% on average and 10.7% and 11.8% for boys and girls, respectively but with no significant difference (P>0.05). Rates on abdominal obesity appeared as 13.2% and 8.5% for boys while as 12.3% and 11.2% for girls respectively, in urban or rural areas. As for the levels of family income, the abdominal obesity rates appeared as 15.8%, 11.5% and 8.8% respectively for boys while 13.5%, 11.9% and 11.6% respectively for girls, under high, middle and low levels of family income. Conclusion: The rate of abdominal obesity in boys seemed more responsive to the impact of income in urban or rural areas.
Adolescent ; Asian People/statistics & numerical data* ; Child ; China/epidemiology* ; Cities ; Female ; Humans ; Male ; Obesity, Abdominal/ethnology* ; Prevalence ; Waist Circumference

BACKGROUND: Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes. METHODS: We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. RESULTS: The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. CONCLUSIONS Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.
Cities/statistics & numerical data* ; Geography ; Hospitals, Teaching/statistics & numerical data* ; Japan ; Physicians/statistics & numerical data* ; Population Density ; Salaries and Fringe Benefits/statistics & numerical data* ; Students, Medical/psychology* ; Workload/statistics & numerical data*

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9, 212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants' incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100, 000 and income of the administrative unit were found to be significant determinants, but only in city environments.
Urban Health ; Rural Health ; Private Practice/*organization & administration ; Korea ; Geography ; Efficiency, Organizational/*statistics & numerical data ; Cities ; Ambulatory Care Facilities/economics/*organization & administration/statistics & numerical data

OBJECTIVETo investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing.

METHODSA cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews.

RESULTSThe incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age (χ2for trend=21.06, 19.20, P=0.001, 0.002). Binary logistic stepwise regression analysis showed that age (OR=2.20), living alone (OR=4.67) and gait disturbance (OR=1.27) were risk factors, while housing with elevators (OR=0.35), appropriate width/height of stair steps (OR=0.78), sufficient lighting for stairway (OR=0.45) and regular exercise (OR=0.12) could lower the risk for single fall; factors such as low monthly family income (OR=1.39), poor vision (OR=1.83), low physical ability (OR=4.47), abnormal static balance (OR=2.48), and fear of falls(OR=2.23) were risk factors, while appropriate width/height of stair steps (OR=0.49) and easiness of access to daily supplies (OR=0.41) were protective factors for recurrent falls.

CONCLUSIONThe incidence of falls in community-dwelling elderly people in Beijing is common, and falls and their related injuries have been associated with both intrinsic and extrinsic factors.

Accidental Falls ; statistics & numerical data ; Aged ; Aged, 80 and over ; China ; epidemiology ; Cities ; statistics & numerical data ; Female ; Humans ; Incidence ; Male ; Recurrence ; Wounds and Injuries ; epidemiology