Hepatitis B is a very common communicable disease in China but the prevalence of hepatitis B virus (HBV) infection in patients with autoimmune diseases is unknown. We retrospectively investigated the prevalence of autoimmune diseases in patients with HBV infection. The medical records of 4060 patients with autoimmune or nonautoimmune diseases were reviewed. A positive test result for hepatitis B surface antigen (HBsAg) was used to indicate the presence of HBV infection. Autoimmune diseases included autoimmune hepatitis, primary biliary cirrhosis, systemic lupus erythematosus and ulcerative colitis. Nonautoimmune conditions included inguinal hernia, appendicitis and pregnant or postpartum women. The proportion of autoimmune disease patients who were HBsAg positive (2.24%) was significantly lower than that of nonautoimmune disease patients who were HBsAg positive (4.58%; P = 0.0014). Regarding hepatic autoimmune diseases, the positivity rates for HBsAg in autoimmune hepatitis patients (0.83%) and primary biliary cirrhosis patients (1.02%) were both significantly lower than in nonautoimmune patients (4.58%; P = 0.006 and 0.004, respectively). Patients with hepatic autoimmune disease were significantly less likely to be HBsAg positive (0.93%) than patients with non-hepatic autoimmune disease (3.99%; P = 0.002). Patients with autoimmune diseases, especially those with hepatic autoimmune disease, may more efficiently clear HBV than patients with nonautoimmune diseases.

ObjectiveDiabetes mellitus is a common condition often associated with an ageing population. However, only few longitudinal studies in China have investigated the incidence of diabetes and identified its risk factors. Therefore, this study aimed to investigate the incidence and risk factors of diabetes in Chinese people aged ≥45 years using the harmonised China Health and Retirement Longitudinal Study (CHARLS) data.DesignA dynamic cohort study.SettingThe harmonised CHARLS 2011–2018.Participants19 988 adults aged ≥45 years.Primary outcome measureIncident diabetes from 2011 to 2018.ResultsThe harmonised CHARLS is a representative longitudinal survey of people aged ≥45 years. Using data extracted from the harmonised CHARLS, we calculated the incidence of diabetes and used a competing risk model to determine risk factors of diabetes. In 2011–2013, 2013–2015, 2015–2018, the crude incidence of diabetes among middle-aged and older people in China was 1403.21 (1227.09 to 1604.19), 1673.22 (1485.73 to 1883.92) and 3919.83 (3646.01 to 4213.30) per 100 000 person‐years, respectively, with a significant increasing trend. There were no geographical variations in the incidence of diabetes. Age, obesity and alcohol consumption were associated with an increased risk of incident diabetes.ConclusionThe incidence of diabetes increased annually, without any geographical differences. Age, obesity and alcohol consumption were found to be risk factors for incident diabetes.

The prevalence and mortality rates of diabetes are increasing globally, posing severe challenges to health systems. Acupuncture is used worldwide as a non-drug treatment for diabetes. However, empirical evidence of the effect of combined acupuncture and drug treatments on diabetic-associated mortality is limited. This study aimed to examine this association of acupuncture treatment with mortality of type 2 diabetes based on real-world data. A four-year cohort study was conducted in Shanghai between 2015 and 2018, The database consisted of 37,718 patients (acupuncture group: 6865 type 2 diabetes mellitus (T2DM) patients, non-acupuncture (control) group: 30,853 T2DM patients) in 2016. The objective was to analyze the impact of receiving acupuncture prescriptions for diabetes in 2016 on all-cause mortality in 2018 based on real-world data. An Inverse Probability Weighted Regression Adjustment (IPWRA) and Propensity Score Matching (PSM) were used to minimize the bias due to potential confounding variables to increase the reliability of differences in comparisons between the two groups. Our inverse probability weighted regression results suggest that the coefficient of the key dependent variable of accepted acupuncture in 2016 was negative (coefficient: −0.0002; 95% CI: −0.0024–0.0019, p = 0.857), but it is not statistically significant. In robustness check, PSM with the nearest-neighbor method with replacement at a 1:4 ratio and 1:3 ratio and kernel matching showed that the average treatment effect was negative. Therefore, there was a negative correlation between acupuncture combined with other drugs and the mortality of diabetic patients, but it was not statistically significant.

Background: Hypertension is a prevalent and costly health condition in China. Little is known about variation of the inpatient and outpatient expenditures attributable to hypertension between prefecture-level administrative regions (PARs) and the drivers of such variation among China’s middle-aged and elderly population. Methods: We obtain data from China Health and Retirement Longitudinal Survey between 2011 and 2015, panel tobit models were used in our study to estimate differences across 122 PARs. Expenditure variation was explained by the characteristics of individuals and regions, including measures of healthcare supply. Results: The cost of treatment for patients with hypertension varies greatly geographically, with the highest outpatient and inpatient costs being 77 and 102 times the lowest, respectively. After adjustment for the individual and PAR character, there are associations between expenditure and region bed density. Conclusion: There were significant regional differences in the outpatient and inpatient costs of middle-aged and elderly patients with hypertension in China, the difference between individuals may be an important reason, which has little to do with regional economic development differences, but is related to regional bed density.

Background The prevention and control of hypertension should be an effective way to reduce deaths and it has been a high priority in China. In 2013, the Chinese government increased the subsidy standard for the National Essential Public Health Services Package (NEPHSP) from RMB 15 to RMB 30 per person, which was expected to cover 70 million hypertensions. This study explored the influence of increasing NEPHSP subsidy on outpatient and inpatient expenditure among patients with hypertension. Methods Data were mined from the 2011–2015 Harmonized China Health and Retirement Longitudinal Study. The study sample included 3192 hypertensive patients who were not lost to follow-up from 2011 to 2015. Hypertensive patients who covered by NEPHSP from 2011 to 2015 were defined as the treatment group, otherwise defined as the comparison group. The policy intervention was the increase of NEPHSP subsidy in 2013, and the years before and after 2013 were respectively considered as pre- (2011) and post-intervention (2015). The primary outcomes variables were the outpatient and inpatient expenditure of patients with hypertension, based on direct spending of outpatients and inpatients separately reported by patients with hypertension. Using propensity score matching (PSM) to match the individual characteristics of hypertension in the treatment group and the comparison group, difference-in-differences (DID) were used to analyze the outcomes. Results The patients with hypertension’ outpatient and inpatient expenditure patterns in the treatment and control group show an increasing trend from 2011 to 2015. After PSM, of the 1 956 hypertensive participants, 369 covered by the NEPHSP before and after 2013. A DID estimate of the increased NEPHSP subsidy was associated with a significant decrease of 1 251.35 RMB (t = 2.13, P = 0.034) in hypertension related inpatient expenditure, no significant change (t = 0.61, P = 0.544) among outpatient expenditure. Conclusions The NEPHSP may reduce inpatient expenditure among hypertension. Further strengthening of the NEPHSP may reduce their burden.