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      Availability and social determinants of community health management service for patients with chronic diseases: An empirical analysis on elderly hypertensive and diabetic patients in an eastern metropolis of China


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          Objective: This study aimed to determine the availability of community health management services and the relevant social determinants for elderly patients with chronic diseases.

          Methods: All data were obtained from the 2013 random sampling household survey on an elderly population conducted by the School of Public Health of Peking University in an eastern metropolis in China. Information from the database of the above survey involving 1495 hypertensive or diabetic patients ≥60 years of age, as representatives of the city, were included. The study described the availability of follow-up services by community doctors among elderly hypertensive and diabetic patients during the 12 months before the survey. An ordinal multinomial logistic regression model was used to conduct the analysis on the influence of socio-economic background upon such availability.

          Results: Eighty-one percent of hypertensive patients and 84.7% of diabetic patients had not received any follow-up service from community doctors within 12 months prior to the survey. Among elderly hypertensive patients, those registered as non-agricultural household members, those with high and above-average income, as well as management personnel of government agencies, enterprises, and social programs have a greater chance of accepting follow-up service by community doctors because of their relatively higher socio-economic rankings. Among elderly diabetic patients, such socio-economic factors had no significant influence on the availability of the follow-up service for chronic diseases.

          Conclusion: The coverage of community health management services for elderly hypertensive and diabetic patients needs improvement. More effort should focus on promoting the availability of community health management services for elderly hypertensive patients, especially those with lower socio-economic status.

          Most cited references37

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          Chronic illness management: what is the role of primary care?.

          An estimated 99 million Americans live with a chronic illness. Meeting the needs of this population is one of the major challenges facing the U.S. health care system today and in the future. Dozens of studies, surveys, and audits have revealed that sizable proportions of chronically ill patients have not received effective therapy and do not have optimal disease control. The consistent findings of generally substandard care for many chronic conditions have spurred proposals that care be shifted to specialists or disease management programs. Published evidence to date does not indicate any clear superiority of these alternatives to primary care. The defining features of primary care (that is, continuity, coordination, and comprehensiveness) are well suited to care of chronic illness. A rapidly growing body of health services research points to the design of the care system, not the specialty of the physician, as the primary determinant of chronic care quality. The future of primary care in the United States may depend on its ability to successfully redesign care systems that can meet the needs of a growing population of chronically ill patients.
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            Socio-economic status and blood pressure: an overview analysis.

            Mortality rates from hypertension related diseases such as coronary heart disease, hypertensive heart disease, stroke and end stage renal disease show an inverse association with socio-economic status (SES). To review the published literature in order to assess whether (i) there is an association between SES and blood pressure (BP), and if so whether this is explained by (ii) SES differences in treatment rates, or (iii) SES differences in established risk factors for hypertension, or (iv) psycho-social factors associated with SES. A narrative systematic review of published articles identified from a MEDLINE search from 1966-1996 and manual searching of the retrieved articles' bibliographies. Lower SES was associated with higher mean BPs in almost all studies in developed countries. This inverse gradient was both stronger and more consistently found in women than in men. The magnitude of the association varied but generally was quite small, with age adjusted mean systolic BP differences of about 2-3 mm Hg between the highest and lowest SES groups. The finding of an SES gradient in BP, despite adjusting for treatment in some studies and the lack of consistent SES differences in hypertension treatment rates, makes differential treatment an unlikely explanation for the SES gradient in BP. A substantial part of the SES gradient was accounted for by the SES gradient in body mass index. Alcohol consumption across SES groups accounted for part of the association in men though few studies examined this issue specifically. In contrast, in undeveloped or developing countries a direct association between SES and BP has often been found which may reflect a higher prevalence of obesity, and higher salt and alcohol intakes among those of higher SES. The SES differences in BP were not detectable in most studies in children. There is little evidence that adverse psycho-social factors associated with low SES cause chronic elevations in BP. A major challenge in reducing the SES gradient in BP is to understand and prevent the SES differences in obesity, which are particularly large in women. Future research should be directed to this question.
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              Association between socioeconomic status and overweight and obesity among Inuit adults: International Polar Year Inuit Health Survey, 2007–2008

              Objectives To evaluate the socio-economic correlates of overweight and obesity among Inuit undergoing rapid cultural changes. Study design A cross-sectional health survey of 2,592 Inuit adults from 36 communities in the Canadian Arctic. Methods Main outcome measures were overweight and obesity (BMI>25 kg/m2 and >30 kg/m2, respectively) and as characteristics were similar, groups were combined into an at-risk BMI category (BMI>25 kg/m2). Logistic regression was used to determine the association between various sociodemographic characteristics and physical activity with overweight and obesity. Results The prevalence of overweight and obesity was 28 and 36%, respectively, with a total prevalence of overweight and obesity of 64%. In analyses of sociodemographic variables adjusted for age, gender and region, higher education, any employment, personal income, and private housing were all significantly positively correlated with an at-risk BMI (p≤0.001). Smoking, Inuit language as primary language spoken at home, and walking were inversely associated with overweight and obesity. Conclusions The current findings highlight the social disparities in overweight and obesity prevalence in an ethnically distinct population undergoing rapid cultural changes.

                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                March 2015
                April 2015
                : 3
                : 1
                : 6-14
                [1] 1School of Public Health, Peking University, Haidian District 100191 Beijing, China
                Author notes
                CORRESPONDING AUTHOR: Weiyan Jian, School of Public Health, Peking University, Haidian District 100191 Beijing, China, E-mail: jianweiyan@ 123456bjmu.edu.cn
                Copyright © 2015 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                : 13 January 2015
                : 9 February 2015
                Section One: The Chronic Disease Challenge for General Practitioners

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                diabetes,socio-economic status,hypertension,elderly population,Community health management


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