Background: We examined the relationship between health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area. Methods: We conducted in-person interviews with 913 rural women aged 23 – 57 (57.5% Hui minorities/42.5% Han ethnicity) enrolled in the Ningxia Women Health Project, gathering data on EQ-5D, self-designed HL, socio-demographic characteristics, and chronic diseases. The extent of impairments in the five dimensions of the EQ-5D was used to measure HRQoL. Factor analysis yielded a single HL factor, which was used as a dichotomous variable in multivariate log-binomial regression models that examined the adjusted association of HL with HRQoL. Results: Nearly half of the women had no formal education. The most prevalent impairments were pain/discomfort and anxiety/depression (42.42% and 32.09%, respectively). The Hui minorities had 1.65 times higher rates of low HL (defined as less than mean of the factor score for HL) and 1.22 and 1.25 times for pain/discomfort and anxiety/depression impairments, respectively. Low HL was associated with poor HRQoL, with a 23% increase in the prevalence of pain/discomfort impairments after adjusting for socio-demographics. This association was significant in the Hui group (PR=1.30, 95% CI=1.06-1.58) but not for the Han group (PR=0.99, 95% CI=0.76-1.30). HL-stratified analysis revealed modification for ethnic disparities in HRQoL; for pain/discomfort impairments, high HL-PR=0.88 (95% CI=0.71-1.08), low HL-PR=1.24 (95% CI = 1.01-1.52); for anxiety/depression impairments, high HL-PR=0.98 (95% CI=0.73-1.32), low HL-PR=1.44 (95% CI = 1.05-1.98). Conclusions: Low HL is associated with poor HRQoL across the entire sample and the association may be modified by ethnicity. Similarly, ethnic disparities in HRQoL may be modified by HL, larger in low HL group. Health services should address HL in vulnerable minority women to improve their HRQoL.

Purpose: Hypertension is a growing public health problem in China; however, little is known about health-related quality of life (HRQoL) especially health state utility (HSU) of patients with hypertension in rural China. This study aimed to examine the HSU as measured by SF-6D and to investigate its associated factors among middle and old aged patients with hypertension in rural China. Methods: Data were collected from twelve villages in Shandong Province in 2016. SF-36 was administrated to measure HRQoL of middle and old aged patients with hypertension and was got to the SF-6D values using Hong Kong’s tariff. Descriptive analyses, such as demographic characteristics, socio-economic status, and utility, were stratified by hypertension classification. Multiple linear regression models were applied to assess the associated factors of HSU. Results: A total of 933 (response rate:86.4%) middle and old aged patients (69.1 ± 8.2 years) with hypertension participated in the study. 39.4% of participants were male; 44.2% had stage I hypertension; 26.4% had stage II and above. The mean score of SF-6D utility score was 0.743 (SD: 0.14, range: 0.32–1.00, median: 0.756, Interquartile range:0.634–0.859). Being female (β = −0.046), having two or more comorbidities (2 vs. 1 β = −0.066; > 3 vs. 1 β = −0.098) and the health expenditure higher than 2000 RMB (2000–3999 vs.< 2000 β = −0.042; 4000–5999 vs. < 2000 β = −0.046; > 6000 vs. < 2000 β = −0.071) were significantly associated with lower SF-6D overall score; while being farmer (β = 0.032), having high household income (10,000–14,999 vs. < 5000 β = 0.045; > 15,000 vs. < 5000 β = 0.064) and having stage I and above hypertension (stage I vs. Normotensive β = 0.047; stage II vs. Normotensive β = 0.079; stage III vs. Normotensive β = 0.095) were significantly associated with higher SF-6D overall score. Conclusion: SF-6D was capable to measure quality of life middle and old aged patients with hypertension in China. And multiple factors were demonstrated to be significantly associated with quality of life.

Purpose: Multimorbidity and polypharmacy have emerged as significant global issues, heightening the risks of potentially inappropriate medications (PIMs). This necessitates medication optimization through deprescribing. Understanding patients’ decision-making preferences regarding medication cessation is crucial for mitigating medication-related risks. This study aims to capture the attitude of patients with multimorbidity towards deprescribing in rural China and to ascertain whether individual characteristics were linked to these attitudes. Patient and Methods: A cross-sectional study employing the validated Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was performed in rural regions of Eastern China. The PATD Questionnaire was utilized to investigate patients’ attitudes towards the concurrent use of multiple medications, with response elicited on a 5-point Likert scale. Utilizing multistage random sampling, a total of 560 participants with multimorbidity were randomly selected from two counties in Shandong Province. Descriptive statistics were reported on participant characteristics. Binary logistic regression analysis was conducted to identify the factors that influenced participants’ willingness to discontinue or reduce their medication. Results: The median age of patients was 69.5 years (SD=8.2 years), and 314 were female. Nearly one in four patients experienced polypharmacy, while 42.2% had two chronic diseases. More than half of the participants (55.2%) reported that they would be willing to stop one or more medications if their physicians agreed, and 52.9% of participants agreed to reduce the medications taken. Participants with two chronic conditions (OR=3.038, 95% CI=1.342– 6.881), taking less than 10 tablets (OR=2.994, 95% CI=1.113– 8.054), having their own source of healthcare expenditure (OR=0.639, 95% CI=0.432– 0.945), and hospitalization in the prior year (OR=0.636, 95% CI=0.429– 0.944) were significantly associated with patients’ attitudes toward deprescribing. Conclusion: Over half of patients with multimorbidity expressed a willingness to have one or more of their medicines deprescribed. Physicians can be trained in the integrated care of chronic diseases and encouraged to engage in discussions about deprescribing with patients having multimorbidity and polypharmacy during their routine practice.

Background: Hypertension is rapidly increasing in China, but control rates are significantly low. There is a pressing need for effective management models in primary community health settings.Methods: In April 2023, 459 patients from six communities in Jinan City were enrolled using a multi-stage random sampling method and assigned to either a control group comprising 243 participants or an intervention group comprising 216 participants. The control group received standard hypertension care, whereas the intervention group participated in a novel IoT-based remote blood pressure monitoring program for 6 months. Data collection was conducted through detailed questionnaire surveys, cloud platform records, and community management records, both before and after the intervention period. The study employed difference-in-differences (DID) and mediation effect models to assess the effects of the IoT-based management model.Results: The DID model demonstrated that the intervention significantly reduced systolic blood pressure by 9.883 mm Hg and diastolic blood pressure by 6.553 mm Hg. The mediation effect model showed that the frequency of blood pressure measurement and attitudes and beliefs toward hypertension treatment had mediating effects, accounting for 5.82 and 8.07% of the total effect, respectively. The heterogeneity analysis revealed significant regional differences: rural residents experienced a greater decrease in systolic and diastolic blood pressures by 14.85 mm Hg and 6.591 mm Hg, respectively, compared to urban residents, whose diastolic pressure decreased by 6.046 mm Hg.Recommendations: It is advisable to develop differentiated hypertension management strategies tailored to specific regional needs to promote the deep integration and widespread application of smart blood pressure monitoring technology. Enhancing patient awareness and capabilities in managing their health condition is crucial for improving the blood pressure control level among community hypertension patients.

Background Over the past decade, China has experienced a surge in doctors and beds, along with significant increase in healthcare utilization. This study compares the need-based and demand-based projections with supply of doctors and beds in China from 2021 to 2025. We also evaluate the adequacy and equitable distribution of doctors and beds. Methods By utilizing public data from 2008 to 2018, we employed the health need method, health demand method, and trend projection to estimate the need and demand for and supply of doctors and beds in China. Results By 2025, the projected need-based, demand-based, and supply of doctors will be 5.93 million, 3.89 million, and 4.40 million, respectively. Correspondingly, bed projections stand at 7.27 million, 6.58 million, and 11.06 million. The study found an inclination toward hospital care, amplified by the need and demand for doctors and beds in hospital sector. Notably, the findings indicate 64.0% and 87.5% of incremental doctors and beds supply will be in hospital sector by 2025, intensifying towards a hospital-centric healthcare system. Conclusion Considering current trajectories, this study reveals an excess supply of doctors and beds in China by 2025, with widening disparities that favour inefficient hospitals than primary care institutions. We recommend the government to emphasize the importance of optimal investment and allocation of doctors and beds between hospital and primary care sectors, reform the payment method in favour of primary care, and reorient public preferences for hospital services, by strengthening the capacity and quality of primary sector in order to gain population’s trust and confidence.

There are very few studies about the quality of care (QoC) in Chinese county hospitals. Using 7, 6, and 6 standard operations from clinical pathways as the process indicators, we evaluated the quality of stroke, pneumonia, and heart failure care, respectively. We also conducted chi-squared tests to detect differences of quality between selected counties or hospitals. We extracted relevant information from medical records of 421 stroke cases, 329 pneumonia cases, and 341 heart failure cases, which were sampled from 6 county hospitals in 3 counties of eastern China. The average proportion of recommended care delivered included stroke, pneumonia, and heart failure patients at 55.36%, 41.64%, and 49.56%, respectively. Great variation of QoC was detected not only across selected counties but between comprehensive county hospitals and traditional Chinese medicine county hospitals. We deny the widely-accepted assumptions that poor QoC should be blamed on defectively-equipped facilities or medicine and overwhelmed care providers. Instead, we speculate the low qualifications of medical workers, failed clinical knowledge translation, incorrect diagnosis, and a lack of electronic systems could be the reasons behind poor QoC. It is high time for China to put QoC as the national health priority.