Background: The World Health Organization highlights the essential role of effective self-management in the prevention and control of chronic diseases, noting that proper self-management can significantly slow disease progression. Stroke, which ranks as the third leading cause of death worldwide, is often accompanied by inadequate self-management among patients. While health information literacy (HIL) has been shown to influence self-management in conditions such as diabetes and hypertension, its role as a mediating factor linking disease perception and health behavior in patients with stroke remains insufficiently explored. Addressing this research gap is vital for developing targeted interventions. Objective: The aim of this study was to investigate the current status of HIL, stroke knowledge, and self-management abilities among patients with stroke in Southwest China. Additionally, the study analyzed the relationships among these three factors and their mechanisms of action, providing evidence to inform the development of effective health education strategies for enhancing self-management in patients with stroke. Methods: A multicenter cross-sectional design was employed, enrolling 514 patients with stroke from the neurology departments of three tertiary general hospitals in Chengdu between September 2022 and March 2023. Data collection used a standardized set of scales: the health information literacy questionnaire for stroke assessed HIL, the stroke prevention questionnaire evaluated knowledge levels, and the stroke self-management assessment scale measured self-management abilities. Regression analysis and bootstrap mediation effect testing were conducted using SPSS software (version 26.0). Results: Patients with stroke had a mean (SD) score of 17.61 (6.46) for stroke knowledge, 61.17 (13.58) for HIL, and 158.70 (19.07) for self-management skills. Correlation analysis indicated a positive correlation of stroke knowledge with both self-management (r=0.668; P<.001) and HIL (r=0.138; P<.001). The mediation test showed a significant mediating effect of HIL between stroke knowledge and self-management (β=0.543; 95% CI: 0.431‐0.663), with an effect share of 82.77%. Conclusion: There is a correlation between HIL and self-management; the higher the HIL, the better is the self-management behavior. Furthermore, HIL partially mediates the effect of stroke knowledge on self-management.

Secondary pneumonia is an important inpatient complication, yet its burden among patients hospitalised for non-communicable diseases (NCDs) in China remains poorly characterised. We aimed to quantify this burden and its association with in-hospital mortality and prolonged length of stay (LOS). We conducted a retrospective observational study of 31,470 NCD inpatient records from a tertiary hospital in southwest China (2023 to 2025). Secondary pneumonia was identified by ICD-10 code J18 in any secondary diagnosis field. Three logistic regression models with patient-level clustered robust standard errors examined (1) factors associated with secondary pneumonia, (2) its association with in-hospital death, and (3) its association with LOS exceeding 10 days. A respiratory failure/ventilation coding proxy was included in Model 1 and excluded from Models 2 and 3 as a potential mediator. Secondary pneumonia was identified in 2.94% of eligible admissions (n = 925), highest among admissions with neoplasms (6.15%). After adjustment, it was independently associated with in-hospital death (OR 3.15, 95% CI 1.75 to 5.67, p < 0.001) and LOS exceeding 10 days (OR 1.76, 95% CI 1.49 to 2.08, p < 0.001). Secondary pneumonia was identified in 2.94% of NCD admissions and was independently associated with in-hospital death and prolonged LOS, with the highest coded prevalence among admissions with neoplasms. These findings support closer monitoring and evaluation of secondary pneumonia in NCD inpatients as a target for hospital quality improvement.

Rationale: Malnutrition remains systematically undercoded in hospital administrative records, despite its high prevalence among patients with non‐communicable diseases (NCDs). China's Diagnosis‐Related Group (DRG) payment reform links reimbursement to secondary diagnosis coding, potentially incentivising changes in clinical documentation. Aims and Objectives: This study evaluates the validity of administrative malnutrition coding and its association with clinical outcomes in the context of DRG reform. Method: A retrospective cross‐sectional study was conducted using administrative data from a tertiary hospital in southwest China (2023–2025), including 31,133 inpatient admissions with a primary NCD diagnosis. Patients were categorised by insurance type: Urban and Rural Residents' Basic Medical Insurance (URRBMI) or Urban Employees' Basic Medical Insurance (UEBMI). Multivariable logistic regression was used to identify predictors of malnutrition coding and estimate associations with in‐hospital mortality and prolonged hospitalisation (LOS > 10 days), adjusting for age, insurance, admission route, and primary diagnosis. Results: The prevalence of coded malnutrition was 8.5%, surging from 5.3% in 2023% to 11.0% in 2024 before stabilizing at 9.2% in 2025. After case‐mix adjustment, the year of admission remained a significant predictor (2024: OR = 2.23; 2025: OR = 1.71). Coded malnutrition independently predicted in‐hospital mortality (OR = 4.35) and prolonged hospitalisation (OR = 1.32). URRBMI patients consistently demonstrated higher coding rates, while the association between malnutrition coding and mortality was stronger in UEBMI patients. Conclusion: Malnutrition coding increased markedly following DRG reform. The robust association with adverse clinical outcomes validates these codes as meaningful markers of nutritional risk. Our findings underscore the need for systematic nutritional screening in hospital admission protocols to ensure equitable and clinically accurate reimbursement.

China’s achievement of near-universal health insurance coverage represents a milestone in the country’s commitment to health equity (Yip et al., 2019; Zhang et al., 2024). The current multi-layer a...