This paper presents a comprehensive review of the impacts of natural polysaccharides on gut microbiota and immune responses as well as their interactions.

Long-term exposure to particulate matter 2.5 μm (PM2.5) air pollution is associated with an increased risk of lung cancer. However, the evidence is limited in low-income and middle-income countries. We estimated the association between the incidence of lung cancer and PM2.5 air pollution exposure in the Urban Employee Basic Medical Insurance (UEBMI) beneficiaries in China. A total of 16 483 new lung cancer cases diagnosed from 12 966 137 UEBMI beneficiaries from 36 cities between 2013 and 2016. The relative risk for lung cancer associated with a 10 µg/m3 increase in 3-year PM2.5 exposure was 1.12 (95% CI 1.00 to 1.26). The population attributable risk estimated for a reduction in PM2.5 concentration to 35 µg/m3 corresponded to a decrease of 14% in cases of lung cancer. Reducing PM2.5 air pollution has a significant public health benefit.

Background: Understanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use. Methods: This study used a 5% random sample of claim data from China’s Urban Basic Medical Insurance between January 2013 to December 2016. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics. Results: In urban China, the annual prevalence of stroke was 730.43 (95% CI = 730.10-730.76) cases per 100 000 people, and nearly 2% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB10 637 [95% CI = 10 435-10 840] (US$1682, 95% CI = 1650-1714), with annual out-of-pocket (OOP) cost of RMB3093 [95% CI = 3026-3161] (US$489, 95% CI = 478-500). The average yearly number of stroke-related outpatient visit was 1.67 [SD = 3.39] and inpatient admission was 0.79 [SD = 0.83], with an average cost of RMB440 [SD = 739] (US$70, SD = 117) for outpatients and RMB12 702 [SD = 21 424] (US$2008, SD = 3387) for inpatients. Inpatient costs accounted for 94% (RMB10 034 or US$ 1586) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to 50.6% (RMB5382 or US$ 851) of the average stroke-related medical costs. Conclusion: China’s health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.

Background: It is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China. Methods: We used claims data from China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively. Results: Among 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI: 1.012-1.441) and chemotherapy (1.363, 1.196-1.554), and decreased possibility of choosing surgery (0.850, 0.730-0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions. Conclusion: Comorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.

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