IntroductionDisabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories.MethodData from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant.ResultsTwo thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities.ConclusionFor five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.

Background The assessment and prevention of mineral and bone disorder (MBD) in kidney transplant recipients (KTRs) have not been standardized. This study aimed to evaluate MBD one year after kidney transplantation (KT) and identify the influencing factors of MBD. Methods A total of 95 KTRs in our center were enrolled. The changes in bone mineral density (BMD) and bone metabolism biochemical markers, including serum calcium (Ca), phosphorus(P), 25-hydroxyvitamin D(25(OH)vitD), intact parathyroid hormone (iPTH), bone alkaline phosphatase, osteocalcin (OC), type I collagen N-terminal peptide and type I collagen C-terminal peptide (CTx), over one year after KT were assessed. The possible influencing factors of BMD were analyzed. The relationships between bone metabolism biochemical markers were evaluated. The indicators between groups with or without iPTH normalization were also compared. Results MBD after KT was manifested as an increased prevalence of hypophosphatemia and bone loss, persistent 25(OH)vitD deficiency, and partially decreased PTH and bone turnover markers (BTMs). Femoral neck BMD was positively correlated with body mass index (BMI) and postoperative 25(OH)vitD, and negatively correlated with postoperative PTH. Lumbar spine BMD was positively correlated with BMI and preoperative TG, and negatively correlated with preoperative OC and CTx. BMD loss was positively associated with glucocorticoid accumulation. Preoperative and postoperative iPTH was negatively correlated with postoperative serum P and 25(OH)vitD, and positively correlated with postoperative Ca and BTMs. The recipients without iPTH normalization, who accounted for 41.0% of all KTRs, presented with higher Ca, lower P, higher BTMs, advanced age, and a higher prevalence of preoperative parathyroid hyperplasia. Conclusions MBD persisted after KT, showing a close relationship with hyperparathyroidism, high bone turnover, and glucocorticoid accumulation.

aims: This study was designed to analyze the correlation between single nucleotide polymorphisms (SNP) related to drug metabolism and pharmacokinetic of mycophenolic acid (MPA) during long-term follow-up. background: Mycophenolic acid (MPA) combined with calcineurin inhibitors (CNI) and corticosteroids were most frequently used in clinical.MPA is formed from MMF after hydrolyzation and is then glucuronidated into 7-O-MPA-glucuronide (MPAG). This procedure is regulated by uridine diphosphate-glucuronoxylan transferase (UG/T) family. The excretion of MPAG including renal excretion and biliary excretion. The renal excretion is regulated by MRP-2 and OAT-3 and biliary excretion is regulated by MRP-2, SLCO1B1 and SLCO1B3. objective: This study was designed to analyze the correlation between single nucleotide polymorphisms (SNP) related to drug metabolism and pharmacokinetic of mycophenolic acid (MPA) during long-term follow-up and try to build a model to predict the MPA AUC. method: A retrospective cohort study involving 71 renal transplant recipients was designed. Blood samples were collected to extract total DNAs, followed by target sequencing based on next-generation sequencing technology. MPA area under curve (AUC) was calculated according to formula established in our center. General linear model and linear regression model were used to analyze the association between SNPs and MPA AUC. result: A total of 689 SNPs were detected in our study and 90 tagger SNPs were selected after quality control and linkage disequilibrium analysis. The general linear model analysis showed that 9 SNPs had significant influence on MPA AUC. A forward linear regression was conducted and the model with the highest identical degree (r2=0.55) including 4 SNPs (SLCO1B1: rs4149036 [P<0.0001], ABCC2: rs3824610 [P=0.005], POR: rs4732514 [P=0.006], ABCC2: rs4148395 [P=0.007]) and 6 clinical factors (age [P<0.0001], gender [P<0.0001], the incident of AR [P=0.001], albumin [P<0.0001], duration after renal transplantation [P=0.01], lymphocyte [P=0.026]). The most profound SNP was rs4149036. The subgroup analysis showed that rs4149036 had significantly influence on MPA AUC in older group (P=0.02), high-albumin group (P=0.01), male group (P=0.046) and both within-36-month group (P=0.029) and after-36-month group (P=0.041). The systematic review included 4 studies and 2 of them showed the mutation in SLCO1B1 resulted in lower MPA AUC which was contrary to our study. conclusion: 4 SNPs (rs4149036, rs3824610, rs4148395 and rs4732514) were identified to be significantly correlated with MPA AUC. Systematic review suggested that rs4149036 located in SLCO1B1 was suggested to be the most profound SNP, which had s stronger influence in recipients who were elder, male or with high serum albumin. Furthermore, 6 clinical factors, including age, gender, occurrence of acute rejection, serum albumin, time from kidney transplantation and blood lymphocyte count, can also affect the concentration of MPA. other: The authors declare no conflict of interest, financial or otherwise.

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