To conduct a health economic evaluation of a community-based screening strategy for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shenzhen, Guangdong Province, and to provide evidence for implementation of this screening strategy in primary healthcare facilities in the city.

Community-based DR screening was conducted from August to December 2021 among 1200 T2DM patients recruited from 10 administrative districts in Shenzhen using a two-stage random sampling approach. A Markov model was constructed from a health care services perspective to conduct a cost-effectiveness analysis of the community-based DR screening strategy, with community-based DR screening as the intervention strategy and no screening as the control. Costs, effect sizes, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the results.

Of the 1 097 participants finally included in the analysis, 266 (24.3%) were diagnosed with DR. Through 20 simulated cycles of systematic screening, the control (no screening) and intervention (screening) groups incurred costs of Chinese Yuan (CNY) 38 882.05 and CNY 41 920.75, respectively, and gained 17.13 and 17.42 quality adjusted life years (QALYs), respectively. The incremental cost-effectiveness ratio (ICER) was CNY 10 478.28/QALY. The net monetary benefits were CNY 218 071.06 and CNY 219 409.58 for the control and intervention groups, respectively, with a benefit-cost ratio of 5.23 for the screening strategy (indicating an indirect return of CNY 5.23 per CNY 1 invested). After 20 simulation cycles, the blindness rate was 21.0% (no screening) versus 10.1% (screening), with screening preventing approximately 120 cases of DR-related blindness in T2DM patients. Sensitivity analyses identified the health utility of blind patients and the annual cost of DME treatment as the most influential parameters. Probabilistic analysis showed good willingness-to-pay (WTP) among T2DM patients in Shenzhen, with screening being cost-effective at WTP thresholds > CNY 10 478.28/QALY.

The results demonstrate that the community-based DR screening strategy for T2DM patients in Shenzhen City is cost-effective and can be promoted in primary healthcare facilities in similar urban settings.

To investigate the awareness, treatment, and control rates of chronic obstructive pulmonary disease (COPD) and their influencing factors among residents aged 40 years and older in Nanjing city to provide a reference for the development of COPD prevention and control strategies in the population.

A total of 2 442 permanent residents aged 40 years and older were recruited from urban communities and rural villages in four districts of Nanjing city, Jiangsu province, using a multistage cluster random sampling method. Face-to-face interviews were conducted using the China Chronic Disease and Nutrition Surveillance Questionnaire, and pulmonary function tests were performed from May 2023 to January 2024. The chi-squared test was used to compare differences in COPD awareness, treatment, and control rates, standardized by the 2020 Jiangsu Provincial Census data, across participant characteristics. Factors influencing these rates were analyzed using multivariable logistic regression models.

Of all participants, 262 (10.73%) were diagnosed with COPD, with a standardized prevalence rate of 11.39%. Of the 262 identified COPD patients, 6.87%, 4.20%, and 3.05% reported awareness, treatment, and control of the disease, with standardized rates of 7.24%, 4.41%, and 2.60%, respectively. Multivariable logistic regression revealed that chronic respiratory symptoms (odds ratio [OR] = 4.91, 95% confidence interval [95%CI]: 1.59 - 15.15), family history of COPD (OR = 18.51, 95%CI: 1.68 - 203.89), and smoking cessation (OR = 9.14, 95%CI: 2.52 - 33.15) were associated with increased odds of COPD awareness. In addition, chronic respiratory symptoms were associated with increased odds of treatment (OR = 11.59, 95%CI: 2.76 - 48.72) and COPD control (OR = 8.66, 95%CI: 1.99 - 37.65).

The prevalence of COPD among residents aged 40 and older in Nanjing is relatively high. However, the awareness, treatment, and control rates of COPD among affected residents remain low. Chronic respiratory symptoms, family history of COPD, and smoking status are the main factors influencing COPD awareness, treatment, and control in this population. Comprehensive measures should be implemented to improve the diagnosis, intervention and management of COPD.

To investigate the awareness and satisfaction of women in Jinan, Shandong Province, regarding breast and cervical cancer screening programs, and to analyze their willingness to participate in combined screening for both cancers and the influencing factors, with the aim of providing a reference for promoting combined screening for these cancers.

Using cross-sectional survey methods with a self-developed questionnaire, face-to-face interviews were conducted with 569 women aged 35 - 64 years in Jinan city, Shandong province, from May to July 2024. Participants were recruited through community-based cervical and breast cancer screening programs. The survey collected data on demographic characteristics, awareness of dual-cancer screening, willingness to participate in combined screening, and satisfaction. Data were analyzed using chi-squared tests and binary logistic regression.

A total of 541 valid responses were received. Of the respondents, 87.43% were aware that the government regularly provides free screening for two cancers for women of appropriate age. In addition, 93.16% and 80.78% of respondents were aware of at least one recommended screening method for breast and cervical cancer programs, respectively. For breast cancer screening, awareness of specific methods was as follows: breast examination (79.11%), breast ultrasound (66.54%), and mammography (10.35%). For cervical cancer screening, awareness rates were: HPV testing (74.86%), cytology testing (34.01%), and colposcopy (29.57%). Regarding screening preferences, 77.63% of subjects preferred a single-visit model ("complete both screenings at the same time"), while 17.74% preferred separate visits. Multiple logistic regression identified two independent factors influencing willingness to participate in joint screening: occupation (odds ratio [OR] = 2.63, 95% confidence interval [95%CI]: 1.11 - 6.23) and prior awareness of screening (OR = 6.29, 95%CI: 3.80 - 10.40). Regarding logistics, 99.26% of subjects preferred screening every 1 - 3 years and 71.90% preferred nearby community health centers. Even with full self-payment, 53.05% remained willing to choose community screening. Satisfaction rates were high: 73.94% (process arrangement), 73.57% (technical level of staff), and 72.83% (service attitude). Finally, 98.89% reported that it was convenient to participate.

While most women demonstrate awareness and willingness to participate in combined breast and cervical cancer screening, targeted health education remains necessary. Further research is needed to assess the feasibility of implementing this model in different regional settings.

To explore the association between the ability to diagnose and treat common diseases and the capacity to provide health management services among grassroots doctors, from the perspective of integrating disease treatment and prevention, and to provide a reference for improving grassroots doctors′ health management service capacity.

An online self-administered questionnaire survey was conducted in August 2020 among 8 469 specialists, general practitioners, and rural doctors. Participants were recruited using stratified multi-stage sampling and typical sampling from primary healthcare institutions located in 11 municipalities across eastern, central, and western China. Utilizing a previously self-developed index system for evaluating the health service capabilities of grassroots doctors, the survey questionnaire was designed based on indicators related to health management service capabilities. The questionnaire assessed the health management service capabilities of primary care physicians in three areas: diagnosis and treatment of common diseases, health management, and health promotion.

Of all the participants, 5 288 (62.44%) were practicing (assistant) doctors, 2 201 (25.99%) were rural doctors, and 6 497 (76.72%) were assessed as capable of diagnosing and treating common diseases. Among all the grassroots doctors surveyed, 7 099 (83.82%) had the ability to provide nutritional guidance for children, and 7 068 (83.46%) could conduct physical examinations for children as part of children's health management. Regarding women's health management, 6 746 (79.66%) could provide family planning guidance, 6 539 (77.21%) offered prenatal health guidance, 5 921 (69.91%) provided perimenopausal health care, and 5 456 (64.42%) conducted cervical/breast cancer screening. More than 90% of the participants were assessed as able to conduct health management for the elderly and individuals with chronic conditions. However, only 6 234 (73.61%) had the ability to analyze community health issues.

The ability to diagnose and treat common illnesses significantly affects the capacity of grassroots doctors to deliver health management services. Moreover, there is a noticeable gap in the health management service capabilities among grassroots doctors in China. Therefore, it is crucial to strengthen collaborative service mechanisms between hospitals and primary care institutions.

To develop an evaluation system for assessing multidimensional social deprivation among rural older adults in China, and to provide a measurement tool for understanding the current status of multidimensional social deprivation among this population.

A preliminary multidimensional social deprivation index system for rural older adults was developed through a literature review and expert panel discussions. Eighteen experts in related fields, selected for their expertise and experience, participated in a two-round Delphi consultation to refine and validate the index system. The Analytic Hierarchy Process (AHP) was used to calculate the weights of the indicators at each level, with pairwise comparisons used to ensure consistency in the weighting process.

he expert response rates for the two rounds of consultation were 100.0% and 94.1%, respectively. The coefficient of expert authority, reflecting the experts' credibility, was 0.872 and 0.856 for the two rounds. Kendall's coefficient of concordance (W) for expert opinions was 0.216 and 0.193 (all P < 0.05), indicating moderate agreement among the experts. After expert consultation, a multidimensional index of social deprivation for rural older adults was constructed, including seven first-level indicators and 37 second- level indicators. The experts′ scores for the importance of each indicator, on a 5- point Likert scale, were 4.46 ± 0.74 and 4.52 ± 0.74 in the two rounds of consultation, with coefficients of variation ranging from 0.05 to 0.27 and 0.00 to 0.24, respectively. In the constructed index system, the weights of the first-level indicators ranged from 0.087 1 to 0.213 0, and the weights of the second-level indicators ranged from 0.017 4 to 0.087 3.

The multidimensional index of social deprivation developed for the rural elderly population demonstrates robust scientific validity and reliability. This instrument provides a comprehensive measurement framework and quantitative basis for assessing multidimensional social deprivation in rural elderly communities, while also providing valuable reference points for subsequent research in this area.

To evaluate the performance of the Prophet model in predicting the daily incidence of hand, foot, and mouth disease (HFMD) in Shenzhen city, to analyze the impact of the COVID-19 pandemic, public holidays, and school vacations (summer/winter) on HFMD predictions, and to provide new insights for HFMD surveillance and early warning systems.

Using daily incidence rate data of hand, foot, and mouth disease (HFMD) in Shenzhen city from 2011 to 2023 as a training set, we constructed different Prophet models based on two factors: (1) whether data from the COVID-19 epidemic period were included, and (2) whether holiday effects were adjusted. These models were then used to predict the daily incidence rate from January to July 2024, and the predictions were compared with the actual observations. Model performance was evaluated using four metrics: mean square error (MSE), mean absolute error (MAE), root mean square error (RMSE), and symmetric mean absolute percentage error (SMAPE).

Compared to the Prophet model trained on data during the COVID-19 pandemic, the baseline Prophet model (without pandemic data) achieved reductions in daily average MSE, MAE, RMSE, and SMAPE of 45.64%, 27.63%, 25.89%, and 7.97%, respectively. After controlling for holiday effects, the MAE, RMSE, and SMAPE values remained unchanged. When the prediction horizon exceeded 4 months, the daily MSE decreased by 3.81%. For predictions within 4 months, the model yielded MSE, MAE, RMSE, and SMAPE values (with 95% confidence intervals) of 0.42 (0.33, 0.90), 0.51 (0.45, 0.75), 0.65 (0.57, 0.95), and 0.42 (0.24, 0.44), respectively. In contrast, the predictions at 7 months showed higher errors: MSE 1.78 (0.39, 29.61), MAE 0.94 (0.48, 3.05), RMSE 1.33 (0.63, 5.44), and SMAPE 0.40 (0.33, 0.43).

During the COVID-19 pandemic (2020 - 2022), the daily HFMD incidence rate significantly affected the performance of the Prophet model. While controlling for holidays and school vacations (winter/summer) had a limited effect on short-term predictions, it improved the model′s accuracy for long-term predictions.

To analyze the disease burden and trends of type 2 diabetes mellitus (T2DM) in China from 1990 to 2021, and to predict the T2DM disease burden from 2022 to 2026, providing data support and a scientific basis for the development and evaluation of diabetes prevention and control strategies.

Data on the disease burden of T2DM in China were obtained from the Global Burden of Disease Study 2021 database. The trends in the prevalence, mortality, and disability-adjusted life years (DALYs) rates of T2DM in China from 1990 to 2021 were analyzed. Autoregressive integrated moving average (ARIMA) models, neural network autoregression (NNAR) models, and combined ARIMA-NNAR models for the prevalence, mortality, and DALYs rates of T2DM in China were established based on data from 1990 to 2016 (training set). Model evaluation was performed using data from 2017 to 2021 (test set). The mean absolute percentage error (MAPE), mean absolute error (MAE), and root mean square error (RMSE) were used to compare the fitting and prediction performance of the models, and the best model was selected to predict the disease burden of T2DM in China from 2022 to 2026.

By calculating the rate of change of T2DM in China from 1990 to 2021, the prevalence, mortality, and DALYs rates of T2DM in China in 2021 showed a significant upward trend compared with 1990, and the disease burden was higher in males than in females. The dynamic trends of the predicted values of the ARIMA model, NNAR model, and combined ARIMA-NNAR model were basically consistent with the actual situation, but the values of each evaluation index of the combined prediction model showed that the prediction effect was better than that of the single prediction model. The prevalence, mortality, and DALYs rates of T2DM in China from 2022 to 2026 predicted by the ARIMA-NNAR model were 8 353.71/10⁵, 8 565.00/10⁵, 8 776.30/10⁵, 8 987.60/10⁵, and 9 198.90/10⁵; 12.55/10⁵, 12.78/10⁵, 12.99/10⁵, 13.20/10⁵, and 13.41/10⁵; and 826.79/10⁵, 846.22/10⁵, 864.49/10⁵, 881.86/10⁵, and 898.54/10⁵, respectively.

The combined ARIMA-NNAR model has a good effect in predicting the disease burden of T2DM in China and can provide a reference for short-term prediction of the T2DM disease burden. The prevalence, mortality, and DALYs rates of T2DM in China will continue to increase from 2022 to 2026, indicating that the disease burden of T2DM in China will continue to increase, and the situation of disease prevention and control remains severe.

To analyze the trends in incidence and mortality of stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), among Chinese residents from 1990 to 2021, and to provide a reference for stroke prevention and control strategies in China.

Data on the incidence and mortality of stroke, IS, ICH, and SAH among Chinese residents in 1990 and 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Descriptive analyses were performed using the number of incident cases, incidence rate, number of deaths, and mortality rate. Statistical analyses were conducted using R 4.1.0 software. Trends in the incidence and mortality of stroke and its three subtypes from 1990 to 2021 were analyzed using the overall percentage change and estimated annual percentage change (EAPC).

The number of incident stroke cases, incidence rate (per 100 000), number of deaths, and mortality rate (per 100 000) among Chinese residents increased from 1 685 762, 143.29, 1 530 590, and 130.10 in 1990 to 4 090 480, 287.51, 2 591 647, and 182.16 in 2021, with overall relative percentage changes of 142.65%, 100.64%, 69.32%, and 40.01%, respectively. Both the incidence and mortality rates of stroke showed a significant increasing trend from 1990 to 2021 (EAPC = 2.02% and 1.01%, both P < 0.001). For IS, the number of incident cases, incidence rate, number of deaths, and mortality rate increased from 761 191, 64.70, 427 970, and 36.38 in 1990 to 2 772 053, 194.84, 1 176 952, and 82.72 in 2021, with overall relative percentage changes of 264.17%, 201.13%, 175.01%, and 127.40%, respectively. Both the incidence and mortality rates of IS showed a significant increasing trend (EAPC = 3.56% and 2.74%, both P < 0.001). For ICH, the corresponding figures increased from 774 012, 65.79, 913 023, and 77.61 in 1990 to 1 173 288, 82.47, 1 322 893, and 92.98 in 2021, with overall relative percentage changes of 51.59%, 25.34%, 44.89%, and 19.81%, respectively. Both the incidence and mortality rates of ICH showed a significant increasing trend (EAPC = 0.40% and 0.50%, both P < 0.01). In contrast, for SAH, the figures decreased from 150 559, 12.80, 189 598, and 16.12 in 1990 to 145 138, 10.20, 91 802, and 6.45 in 2021, with overall relative percentage changes of –3.60%, –20.29%, –51.58%, and –59.96%, respectively. Both the incidence and mortality rates of SAH showed a significant decreasing trend (EAPC = –1.69% and –4.02%, both P < 0.001). In both 1990 and 2021, male residents had higher incidence and mortality rates of stroke, IS, and ICH, as well as a higher incidence rate of SAH compared to females, except for the SAH mortality rate. From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased in males (EAPC = 2.33% and 1.51%, 3.98% and 3.25%, 0.70% and 1.01%, respectively; all P < 0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.59% and –3.44%, respectively; both P < 0.05). In females, the incidence and mortality rates of stroke and IS increased (EAPC = 1.61% and 0.40%, 3.15% and 2.12%, respectively; all P<0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.69% and –4.69%, respectively; both P < 0.05). In both 1990 and 2021, the incidence and mortality rates of stroke and its three subtypes increased with age. The incidence rate of stroke decreased in all age groups from 1990 to 2021 (all P < 0.05), except for the 75 - 79 age group, where the difference was not statistically significant. The incidence rate of IS increased in all age groups (all P < 0.05), except for the age group under 20, which showed a decreasing trend, and the 20 - 24 age group, where the difference was not statistically significant. The mortality rate of IS decreased in all age groups (all P < 0.05), except for the 80 - 84 and ≥ 85 age groups, where the differences were not statistically significant. The incidence and mortality rates of ICH and SAH decreased in all age groups (all P < 0.05).

From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased among Chinese residents, while the incidence and mortality rates of SAH decreased. Males and the elderly are high-risk groups for stroke incidence and mortality.

To analyze the trend in the burden of pancreatic cancer among Chinese residents from 1990 to 2021, providing reference data for the prevention and control of pancreatic cancer in China.

Data related to the burden of pancreatic cancer among Chinese residents from 1990 to 2021 were collected from the Global Burden of Disease (GBD 2021) database. Standardized incidence rates, standardized mortality rates, and disability-adjusted life years (DALYs) were extracted for descriptive analysis. The Joinpoint regression model was used to analyze trends in the burden of pancreatic cancer, and the age-period-cohort (APC) model was applied to assess the effects of age, period, and birth cohort on the burden of pancreatic cancer.

The age-standardized incidence rate of pancreatic cancer in China′s overall, male, and female populations increased from 4.54/100 000, 5.55/100 000, and 3.64/100 000 in 1990 to 5.64/100 000, 7.29/100 000, and 4.18/100 000 in 2021, respectively. The average annual percentage changes (AAPCs) were 0.72%, 0.89%, and 0.48%, respectively, with statistically significant increasing trends for the overall, male, and female populations (all P < 0.001). The age-standardized mortality rates increased from 4.83/100 000, 5.91/100 000, and 3.90/100 000 in 1990 to 5.72/100 000, 7.37/100 000, and 4.29/100 000 in 2021, respectively, with AAPCs of 0.56%, 0.55%, and 0.33%, respectively. Statistically significant increasing trends were observed for the overall, male, and female populations (all P < 0.001). The age-standardized disability-adjusted life years (DALYs) rates increased from 123.16/100 000, 151.33/100 000, and 95.37/100 000 in 1990 to 137.23/100 000, 179.36/100 000, and 96.89/100 000 in 2021, respectively, with AAPCs of 0.36%, 0.55%, and 0.07%, respectively. Statistically significant increasing trends were observed for the overall and male populations (all P < 0.001). The risk of pancreatic cancer incidence increased with age for both males and females. The age effect coefficients were lowest for the 15 - 19 age group (–3.638 and –3.406, respectively), highest for males in the 85 - 89 age group (1.623), and highest for females in the 80 - 84 age group (1.582). The risk of pancreatic cancer incidence increased over time, with period effect coefficients increasing from –0.477 and –0.388 in 1992 - 1996 to 0.488 and 0.382 in 2017 - 2021 for males and females, respectively. The risk of pancreatic cancer incidence decreased with birth cohort, with the lowest cohort effect coefficients observed in 2002 - 2006 (–1.719 and –1.877 for males and females, respectively) and the highest in 1897 - 1901 (1.374 and 1.504, respectively). The risk of pancreatic cancer mortality generally increased with age for both males and females. The age effect coefficients were lowest for the 15 - 19 age group (–3.658 and –3.428, respectively), highest for males in the 90 - 94 age group (1.751), and highest for females in both the 80 - 84 and 85 - 89 age groups (1.686 for both). The risk of pancreatic cancer mortality increased over time, with period effect coefficients increasing from –0.465 and –0.384 in 1992 - 1996 to 0.477 and 0.366 in 2017 - 2021 for males and females, respectively. The risk of pancreatic cancer mortality decreased with birth cohort, with the lowest cohort effect coefficients in 2002 - 2006 (–1.794 and –1.964 for males and females, respectively) and the highest in 1897 - 1901 (1.456 and 1.594, respectively). The risk of pancreatic cancer burden generally increased with age for both males and females. The age effect coefficients were lowest for the 15 - 19 age group (–3.069 and –2.834, respectively) and highest for the 70 - 74 age group (1.049 and 1.286 for males and females, respectively). The risk increased over time, with period effect coefficients increasing from –0.358 and –0.252 in 1992 - 1996 to 0.364 and 0.260 in 2017 - 2021 for males and females, respectively. The risk of pancreatic cancer burden decreased with birth cohort, with the lowest cohort effect coefficients in 2002 - 2006 (–1.334 and –1.513 for males and females, respectively) and the highest in 1897 - 1901 (1.000 and 1.114, respectively).

From 1990 to 2021, the age-standardized incidence, mortality, and DALY rates of pancreatic cancer in the Chinese population, as well as the age-standardized DALY rate in males, showed an increasing trend. The risk of pancreatic cancer burden increased with age and period but decreased with birth cohort.