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      The Ecology of Medical Care in Beijing

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          Abstract

          Background

          We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings.

          Methods

          A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics.

          Results

          On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing.

          Conclusions

          This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

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          Most cited references18

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          Major causes of death among men and women in China.

          With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China. Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent. We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent. Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China. Copyright 2005 Massachusetts Medical Society.
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            The ecology of medical care revisited.

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              Asian medicine. The new face of traditional Chinese medicine.

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                5 December 2013
                : 8
                : 12
                : e82446
                Affiliations
                [1 ]General Practice and Continue Education School, Capital Medical University, Beijing, China
                [2 ]Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
                [3 ]School of Yan Jing Medical Sciences, Capital Medical University, Beijing, China
                [4 ]Laboratory of Parallel Software and Mathematic Science, Institute of Software, Chinese Academy of Sciences, Beijing, China
                [5 ]Beijing Nuclear Industry Hospital, Beijing, China
                [6 ]Lynwood Medical Centre, Lynwood, Western Australia, Australia
                [7 ]School of Medical Sciences, Edith Cowan University, Perth, Australia
                Iran University of Medical Sciences, Islamic Republic of Iran
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: SS WW. Performed the experiments: SS FFZ JW LF YHF JJW CW. Analyzed the data: XQL JD YXY. Contributed reagents/materials/analysis tools: FFZ SS JW WW. Wrote the manuscript: WW SS KK XWY YXW.

                Article
                PONE-D-13-24939
                10.1371/journal.pone.0082446
                3855438
                24340029
                0b7fe4ce-d88e-4b7c-b643-68bc1800c13d
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 June 2013
                : 24 October 2013
                Funding
                This work was financially supported by the grants from the China National "12th Five-Year" Plan for Science and Technology Support (Grant No: 2012BAI37B03), the China National High Technology Research and Development Program-863 (Grant No: 2006AA02Z434), and the Australia-China Science Research Fund (Grant No: ACSRF06444). WW is supported by the Importation and Development of High-Caliber Talents Project of Beijing Municipal Institutions, China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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