BackgroundDaytime napping has been postulated as both a protective and a risk factor for depression in previous studies. In addition to these conflicting results, research gaps also exist with regard to controlling confounding bias between daytime napping and depression and examining the potential association within the Chinese population. To facilitate the prevention and diagnosis of depression, this study aims to provide insight into the association of daytime napping and depression in 0.5 million Chinese adults by fully controlling confounders, and further examine the modifying effects of socio-economic status (SES) and age.MethodsData were drawn from the baseline of a Chinese cohort study of 0.5 million adults. Depressive status was measured by the Composite International Diagnostic Inventory (CIDI). Logistic regression models were used to examine the association between depression and daytime napping adjusted for SES, sleep-related factors, lifestyle factors and related diseases. Further stratified analyses were conducted to identify the modifying effects of socio-economic status and age.ResultsThe odds ratio of depression by daytime napping was 1.15 (95% CI: 1.01–1.31) in females and 1.42 (95% CI: 1.18–1.71) in males. Factors including living in a rural area (OR = 1.31, 95% CI: 1.13–1.52), receiving less education (OR = 1.42, 95% CI: 1.22–1.66), getting married (OR = 1.24, 95% CI: 1.10–1.40) and being 45–65 years old (OR = 1.29, 95% CI: 1.12–1.49) had a modifying effect on daytime napping and depression that could strengthen the association.ConclusionsA significantly positive association was found between depression and daytime napping, as well as daytime dysfunction, snoring and both shorter and longer sleep duration. Lower SES and age could possibly modify the association. Further clinical or epidemiological studies are needed to investigate the mechanism and facilitate the prevention of depression.

ObjectivesTo evaluate health inequity on access to services in the ethnic regions of Northeastern Myanmar from three points of analysis: geographic barrier, gender-based disparity and financial burden of health services.SettingA multistage-stratified random cluster survey was conducted in Shan State Special Region 2 and Eastern Shan State Special Region 4 of Northeastern Myanmar in 2016, including a total number of 774 households.ParticipantsA total number of 4235 participants were recruited during the survey.Primary and secondary outcome measuresGeographic distance, gender, household income and inpatient/outpatient service utilisation.ResultsThe study results showed that residents living within 5 km of any form of healthcare facilities paid more outpatient visits (90.06 visits per thousand population) in the past 2 weeks, compared with those living 5–20 km and over 20 km (54.84 and 54.02 per thousand population, respectively) from healthcare facilities. A similar trend with little significant differences was found for inpatient service use. Regarding household income, adults with an annual household income of above US$720 were more likely to seek outpatient service (OR=1.43, 95% CI 0.98 to 2.10) compared with those with an annual income of

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