Background: Some previous studies have assessed catastrophic health expenditure (CHE) in households with hypertensive patients, but few have examined the difference of CHE in hypertensive patients with and without complications. The purpose of this study is to compare the incidence and determinants of CHE between hypertensive patients with and without complications. Methods: Data of this study were from a cross-sectional study in Shandong Province in China in 2016. Of the recruited 3457 hypertensive patients registered in the NCDs management system in the sampling villages, 3113 completed the survey, with a response rate of 90.05%.CHE was defined as out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay (non-food expenditure). Hypertension complications (e.g., stroke, coronary heart disease, hypertensive kidney disease, etc.) were collected in this study, which was categorized into 0 (no), 1(single), and 2 and more according to the types of hypertensive complications. We employed Chi-square test to explore associated factors and logistic regression model to identify the determinants of CHE. Results: The incidence of CHE and impoverishment is 13.6 and 10.8% among hypertensive patients. The incidence of CHE with one complication is 25.3% (Ρ = 0.000, OR = 2.29) and 47.3% (P = 0.000, OR = 3.60) in patients with two or more complications, which are both statistically higher than that in patients without complication (6.1%). Across all types of patients, income levels are inversely related to the incidence of CHE. Patients who use outpatient or inpatient service are more likely to experience CHE (Ρ = 0.000). Factors including living arrangements, family size, educational attainment are found to be significantly associated with CHE in some subgroups (Ρ <0.05). Conclusions: CHE and impoverishment incidence among hypertensive patients are both high in rural China. Patients with hypertensive complication are at higher catastrophic risk than those without complication. More attention needs to be paid to households with hypertension patients, especially for those with hypertension complications.

Compared with the Expanded Program on Immunization (EPI) vaccines, the coverage rate of the non-EPI vaccines is still low. The aim of this study is to explore the rural-urban disparity in category II vaccine and its determinants among children under 5 years old in China. A cross-sectional study was conducted in 17 cities in Shandong province from August to October, 2013. A total of 1638 children were included in the analysis. Unadjusted and adjusted regression model were used to identify the rural-urban difference in vaccination of category II vaccine. Multivariate logistic regression models were employed to analyze the determinants associated with vaccination of category II vaccine in rural and urban areas respectively. The coverage rates of category II vaccine in rural and urban children were 81.5 and 69.4% respectively. Factors including age and satisfaction with vaccination services were associated with category II vaccination both in rural and urban children (Ρ < 0.05). It was also found that the households with four or less members are more likely to vaccinate category II vaccine in rural children. There was a big difference between rural and urban children in the use of category II vaccine. The government should strengthen financial support and regulation for the category II vaccine. The identified at-risk factors, including age, satisfaction with the vaccination services, and family size should be taken into account when designing targeted vaccination policies for rural and urban children.

Although massive studies have explored the risk factors of suicidal ideation (SI), the prevalence of SI and its associated factors in the hypertensive individuals are largely unknown. This study aims to investigate the factors associated with SI in the hypertensive individuals. Three thousand nine hundred eleven hypertensive individuals in Shandong, China were included in the analysis. SI was assessed by using a question from the NCS (National Comorbidity Survey). We used binary logistic regression analysis to explore the factors associated with SI, and path analysis to test the direct and indirect relationships between associated factors and SI among hypertensive patients. The prevalence of SI in the hypertensive individual was19.6%. Psychological distress had the greatest direct (β = 0.640, p-value <0.01) and total effect (β = 0.640, p-value <0.01) on SI. Other factors including comorbidity (β = 0.090, p-value <0.01), gender (β = 0.088, p-value <0.01), marital status (β = − 0.037, p-value <0.01), economic status (β = − 0.106, p-value <0.01), residence (β = − 0.050, p-value <0.01), alcohol use (β = 0.011, p-value <0.01), exercise (β = − 0.114, p-value <0.01), hospitalization (β = 0.041, p-value <0.01) only had indirect effects on SI. Psychological distress was a mediator between SI and those variables. A significant mediation effect of psychological distress on the associations between SI and some associated factors (i.e., economic status, comorbidity) was demonstrated.