To investigate the spatiotemporal inequity and determinants of maternal healthcare service levels across Chinese provinces.

Based on panel data from 31 provinces in China (2010—2020), a composite maternal healthcare service index was constructed using the entropy weight method. Spatial Gini coefficient, spatiotemporal cluster, and outlier analyses were employed to reveal the evolution of spatial inequity and geographical agglomeration patterns. The Bayesian spatiotemporally varying coefficients (BSTVC) model and spatiotemporal variance partitioning index (STVPI) were then applied to quantify the spatiotemporally heterogeneous effects of socioeconomic and environmental factors.

Persistent spatial inequity exists in China’s maternal healthcare services, exhibiting a solidified pattern of “high in the north, low in the west, and rising in the central region.” Socioeconomic factors contributed 59.66% to the overall spatiotemporal disparity, making them the dominant drivers, among which illiteracy rate accounted for 36.69% as the most critical inhibitory factor.

Although the overall equity of maternal healthcare services in China has improved, significant regional disparities persist. Time- and location-specific interventions are required to promote balanced development of maternal health services.

To develop a comprehensive evaluation index system for community-based rehabilitation interventions tailored to China, addressing various adverse outcomes among patients with severe mental disorders, and to provide an assessment tool for improving the community-based rehabilitation management system at the grassroots level.

The indicator system was developed based on the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework, in conjunction with China’s guidelines for the management and treatment of severe mental disorders. Using the Delphi expert consultation method, we conducted two rounds of expert consultations with 15 experts to select the evaluation indicators, and then applied the Analytic Hierarchy Process (AHP) to calculate the weights of each indicator, thereby establishing an indicator system.

The questionnaire response rate was 100% in both rounds of expert consultation, with an expert authority coefficient of 0.85. The final indicator system comprises 4 first-level indicators, 13 second-level indicators, and 22 third-level indicators. The first-level indicators, ranked by weight from highest to lowest, are: risk behaviors (0.389 0), disease status (0.273 4), social functions (0.224 6), and mental functions (0.113 0).

The indicator system developed in this study focuses on the comprehensive rehabilitation levels of patients with severe mental disorders across multiple dimensions of adverse outcomes. It demonstrates good scientific validity and reliability and can serve as an assessment tool for evaluating community-based rehabilitation outcomes and improving services.

To investigate the association of teeth number and hearing difficulty with mild cognitive impairment (MCI) among community-dwelling older adults (≥60 years) in Henan Province, and to analyze their independent and joint effects on MCI.

Data were obtained from the 2023 Henan Healthy Aging Survey, which used a multistage stratified probability-proportional-to-size (PPS) sampling method to recruit 9 180 residents aged ≥60 years across 17 cities in Henan Province. Information was collected via questionnaires, physical examinations, and biochemical tests. Weighted multivariate logistic regression models were used to analyze the independent effects of tooth number and hearing difficulty on MCI. Multiplicative and additive interactions between the two factors were assessed using the multiplicative interaction term, along with relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI).

Among 9 147 older adults, totally 24.6% was with MCI. The results revealed a significant association between the number of teeth and MCI. Compared to older adults with <10 teeth, those with more teeth had successively lower odds of MCI: 10-19 teeth (OR=0.76, 95%CI:0.60-0.95,P=0.015), 20-27 teeth (OR=0.71, 95%CI=0.58-0.88,P=0.001), and ≥28 teeth (OR=0.66, 95%CI: 0.53-0.83,P<0.001). Hearing difficulty was also significantly associated with MCI. Compared to older adults without hearing difficulties, those with hearing difficulties have a higher likelihood of developing MCI, with this association being more pronounced in individuals with bilateral hearing difficulties (unilateral: OR=1.41, 95%CI: 1.15-1.75,P=0.001; bilateral: OR=1.78, 95%CI: 1.50-2.11,P<0.001). The interaction results showed that there was no multiplicative interaction between the number of teeth and hearing difficulty on MCI (OR=0.83, 95%CI: 0.62-1.11,P=0.203), nor an additive interaction (RERI, API, and SI of the interaction were -0.17 (95%CI:-0.56-0.21), -0.09(95%CI: -0.29-0.10), 0.83 (95%CI: 0.60-1.26), respectively).

Maintaining more teeth and no hearing difficulty contributed to improve cognitive function. It is recommended to conduct simultaneous screening for oral and hearing health, enhance health education and encourage regular check among the elderly population, and the inclusion of early screening in basic public health services is recommended for decelerating the progression of cognitive decline.

To analyze the association between the sleep quality and daily living activity ability (ADL) of community-dwelling elderly in Jiading District, Shanghai, and to explore the mediating role of intrinsic capacity (IC).

: A multi-stage cluster random sampling method was used to conduct a questionnaire survey among 4 462 community-dwelling elderly aged 60 and above in Jiading District. The Pittsburgh Sleep Quality Index (PSQI), IC assessment tool, Basic Activities of Daily Living (BADL), and Instrument Activities of Daily Living (IADL) scale were used for evaluation. Pearson correlation analysis, linear regression models, and the Bootstrap method were used for statistical analysis.

: The scores of BADL and IADL were (98.12±7.72) and (7.60±1.25) respectively. The detection rate of sleep disorders was 32.52%, and the impairment rate of IC was 83.03%. The PSQI score was negatively correlated with the BADL/IADL scores (BADL:r=-0.13,P<0.01; IADL:r=-0.17,P<0.01). The IC score was also negatively correlated with the BADL/IADL scores (BADL:r=-0.32,P<0.01; IADL:r=-0.40,P<0.01). IC played a partial mediating role in the relationship between sleep quality and BADL/IADL, with the mediating effect accounting for 41.40% and 28.57% respectively.

: The sleep quality of community-dwelling elderly is closely related to their ADL, and IC plays a partial mediating effect. Improving sleep quality and enhancing IC may help delay functional decline and promote healthy aging.

To analyze the spatial distribution characteristics and equity of methadone maintenance treatment (MMT) resources in Guangdong Province from 2017 to 2022，and to provide evidence for optimizing resource allocation.

Kernel density analysis was used to analyze the spatial distribution characteristics. The Gini coefficient, Lorenz curve, and Health resource agglomeration degree (HRAD) was employed to evaluate the overall and inter-regional equity of MMT resource allocation in Guangdong Province.

The spatial distribution of MMT clinics in Guangdong Province showed significant clustering, mainly concentrated in the Pearl River Delta (PRD) region, Jieyang and Shantou City in the eastern region, and Zhanjiang and Maoming City in the western region of the province. From 2017 to 2022, the number of MMT participants in Guangdong Province decreased from 8 237 to 3 630, whereas the number of MMT clinics increased from 66 to 75. During the same period, the Gini coefficient increased from 0.22 in 2017 to 0.29 in 2021, and then decreased to 0.23 in 2022. The HRAD of MMT resource increased from 1.65 to 5.23, and then declined to 2.08 in 2022, with marked variation across regions. Taking the year 2020 as an example, HRAD across cities in Guangdong Province ranged between 0.46 to 73.79. Specifically, the western region had an HRAD closest to 1 (0.87), while the eastern region had the highest value of 18.13, followed by the northern region (6.03) and the PRD (1.65), respectively.

From 2017 to 2022, MMT resources in Guangdong Province showed a clustering distribution, mainly in PRD region. The overall allocation of MMT resource was relatively equitable; however, a significant inter-regional disparities remained, suggesting an oversupply in eastern and northern Guangdong. MMT resource allocation should therefore be dynamically adjusted according to the local scale and changing trends of MMT participants in order to improve equity and utilization efficiency.

To analyze the structural characteristics and core influencing factors of health literacy among residents in Sichuan Province during the 14th Five-Year Plan period (2021-2025), and provide empirical evidence for formulating health literacy optimization strategies for the 15th Five-Year Plan period.

Based on the health literacy surveillance data of Sichuan residents in 2021, 2023 and 2025, Chi-square test was used to analyze the structural characteristics of literacy on six categories of health issues, multivariate Logistic regression was applied to identify the influencing factors, and stepwise regression method was adopted to test the mediating effect of education level.

During the 14th Five-Year Plan period, the overall health literacy rate of Sichuan residents increased from 24.10% to 33.80%, with a cumulative increase of 9.70 percentage points, and the level in 2025 was slightly higher than the national average. The literacy on six categories of health issues presented the characteristics of prominent strengths, obvious weaknesses, and peaking then declining in some dimensions: scientific health concept and safety & first aid were dominant fields, while chronic disease prevention and control, infectious disease prevention and control were core weaknesses. Education level of college degree or above (OR=5.467，95%CI=5.453-5.481) and occupation as medical staff (OR=1.796，95%CI=1.790-1.802) were strong promoting factors, while rural household registration, people aged 65-69 years and farmers were main risk factors. The mediating effect of education level accounted for 35.2% and 42.6% of the association between urban-rural status, farmer occupation and health literacy, respectively.

The health literacy of Sichuan residents has achieved significant improvement, but prominent problems such as structural imbalance, regional and population disparities still exist. Education level is the core mediating variable. Targeted optimization strategies should be implemented to promote the transformation of health literacy to qualitative optimization.

To analyzes the influencing factors of outpatient and inpatient service utilization among middle-aged and elderly people in China based on the Andersen model.

Using the 2020 Chinese Health and Aging Tracking Survey Database as the basis, the study focused on middle-aged and elderly individuals aged 45 and above. Chi-square test, binary logistic regression, and CHAID decision tree were employed to predict the influencing factors.

The outpatient utilization rate among middle-aged and elderly people was 20.32%, and the inpatient utilization rate was 16.78%. Logistic regression showed that the main influencing factors for outpatient utilization were self-assessed health (general OR=0.310, 95%CI: 0.242-0.397 or good OR=0.611, 95%CI: 0.512-0.730), the number of chronic diseases (≥ 2 types OR=2.288, 95%CI: 1.877-2.790 or having 1 type OR=1.510, 95%CI: 1.272-1.794), and being affected by medical treatment during the epidemic (OR=2.755, 95%CI: 2.292-3.313). Urban employee medical insurance (OR=0.577, 95%CI: 0.361-0.923), having internet access in the past month (OR=1.198, 95%CI: 1.025-1.401), age 60-69 years old (OR=1.188, 95%CI: 1.007-1.401), and having running water (OR=0.739, 95%CI: 0.584-0.937). The main influencing factors for inpatient utilization were self-assessed health (general OR=0.238, 95%CI: 0.182-0.311 or good OR=0.400, 95%CI: 0.331-0.482), the number of chronic diseases (≥ 2 types OR=2.410, 95%CI: 1.957-2.967 or having 1 type OR=1.628, 95%CI: 1.352-1.959), IADL impairment (OR=1.346, 95%CI: 1.103-1.643), being affected by medical treatment during the epidemic (OR=1.657, 95%CI: 1.351-2.031), having internet access in the past month (OR=0.776, 95%CI: 0.653-0.922), and being elderly (70-79 years old OR=1.292, 95%CI: 1.017-1.641; ≥ 80 years old OR=1.476, 95%CI: 1.005-2.169). The CHAID decision tree further revealed that being affected by medical treatment during the epidemic was the primary stratification factor for outpatient utilization, and self-assessed health was the primary stratification factor for inpatient utilization. Both models demonstrated good predictive performance, with similar values of the area under the ROC curve.

Logistic regression and CHAID decision tree can complementarily analyze the influencing mechanisms of health service utilization. Policies should focus on middle-aged and elderly people with poor self-assessed health, chronic disease comorbidity, IADL impairment, and high age, and establish a medical service guarantee mechanism for the elderly in the event of a public health emergency.

To evaluate the textual quality of China’s provincial public health emergency response plans from a central-local comparative perspective, to analyze the differences in plan quality across regions, and to provide empirical evidence for plan revision.

An evaluation framework integrating feature words, text similarity, and the PMC index was constructed to assess the textual quality of the national and provincial public health emergency response plans.

A total of 28 plans were included. The high-frequency feature words reflected the main structural framework of the plans, with terms such as “Party Committee”, “Command Headquarters”, and “Joint Prevention and Control” appearing frequently. With the national plan as the benchmark, the similarity of provincial plans was classified into high, medium, and low levels. The overall PMC index of the plans was 5.99, with scores ranging from 2.56 to 8.35. The results of text similarity and the PMC index were mutually validated.

China’s concept for compiling health emergency plans has been upgraded. Plan contents differ in their emphasis on completeness versus local characteristics. Text similarity reflects the balance between “normativity” and “autonomy” in provincial plans, which extends the understanding of inter-governmental differences in plan textual quality and offers a new perspective for understanding such differences. Provincial plans should remain consistent with the national framework while incorporating localized interpretations based on local conditions, so as to effectively guide regional health emergency practices.

To analyze the spatiotemporal distribution and equity evolution of psychiatric health resources and service levels in China from 2014 to 2023.

Equity was measured using the Gini coefficient and Lorenz curve, the sources of inequality were decomposed by the Theil index, and spatial clustering characteristics were analyzed via global and local Moran I.

From 2014 to 2023, the compound annual growth rates for psychiatric beds, outpatient and emergency visits, and discharges were 13.86%, 9.17%, and 11.67%, respectively. The Gini coefficient for outpatient and emergency visits based on population decreased from 0.332 to 0.198, indicating continuous improvement, while all indicators based on geographical area remained above 0.65. Theil index decomposition showed that population-based inequality was mainly driven by intra-regional differences, whereas geography-based inequality was dominated by inter-regional disparities. Spatial analysis revealed significant positive autocorrelation for beds and outpatient/emergency visits, with high-high clusters in the Yangtze River Delta and persistent low-low clusters in northwestern China.

Over the past decade, China has experienced rapid growth in psychiatric resources and significant improvement in population-based equity, yet geographical accessibility remains weak. Future policies should balance population needs with geographical reach, narrowing inter-regional gaps and addressing intra-regional imbalances through regional collaboration and telemedicine.

To investigate the interaction between leisure-time physical activity (LTPA) and sex on sleep quality among rural older adults in Chengdu.

Observational analysis was conducted based on data from a cluster randomized controlled trial. The Physical Activity Scale for the Elderly (PASE) was used to assess the level of LTPA; a higher PASE score indicates a higher level of LTPA. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality; a higher PSQI score indicates poorer sleep quality. A linear mixed model was used to analyze the interaction between LTPA and sex on sleep quality, and stratified and joint analyses were further conducted.

A total of 511 participants were included in this study, with a mean age of 70.94 years, of whom 284 were female. The interaction between LTPA and sex on sleep quality was significant (P=0.001). Stratified by LTPA level, female PSQI scores were significantly higher than those of males in the low, relatively low, and relatively high LTPA groups (low level: β=2.66, P=0.003; relatively low level: β=2.78, P<0.001; relatively high level: β=1.51, P=0.006). Stratified by sex, only in females did the relatively high and high LTPA groups have significantly lower PSQI scores compared with the low LTPA group (relatively high level: β=-0.61, P=0.050; high level: β=-0.98, P=0.003). Joint analysis showed that using the "low LTPA level + female" group as the reference, males had significantly lower PSQI scores than the reference group across all LTPA levels (all P<0.001), whereas females had significantly lower PSQI scores than the reference group only in the relatively high and high LTPA groups (relatively high level: β=-0.65, P=0.021; high level: β=-1.01, P<0.001).

There is a significant interaction between LTPA and sex on sleep quality among rural older adults in Chengdu. It is suggested that future sleep intervention programs should be tailored according to sex and LTPA level.