Background: As China embraced an aging society, the burden of age-related diseases had increased dramatically. Knowledge about spatial distribution characteristics of disease burden and the influencing factors of medical expenditure is of great significance to the formulation of health policies. However, related research in rural China is still insufficient.Methods: A total of 5,744,717 records of hospitalized rural elderly in southeast China were collected from 2010 to 2016. We described the temporal trends of hospitalization medical expenditure and the prevalence of catastrophic health expenses (CHE) in the rural elderly by common diseases. Then, geographical information tools were used for visualization of geographic distribution patterns of CHE, the ordinary least squares methods (OLS) and geographically weighted regression (GWR) were employed to examine the influencing factors of medical expenditure.Results: The number of CHE hospitalizations and the total number of hospitalizations for the rural elderly people increased by 2.1 times and 2.2 times, respectively, from 2010 to 2016. Counties with a high prevalence of CHE were clustered in the eastern coastal area (Moran's I = 0.620, P < 0.001, General G < 0.001, P < 0.001). Unspecified transport accidents, cardiovascular disease, and essential hypertension were the top causes of CHE in the rural elderly. Adequate hospital beds (P < 0.05) and reasonable utilization and distribution of town-level (P < 0.001) and county-level hospitals (P < 0.001) may help reduce medical expenditures.Conclusions: In the context of an aging society, the disease burden for the elderly in rural areas should arouse more attention. These findings highlight the importance of age-related disease prevention and the rational allocation of medical resources in rural areas.

Background Despite the known increasing incidence of breast cancer in China, evidence on the spatial pattern of hospitalization for breast cancer is scarce. This study aimed to describe the disparity of breast cancer hospitalization in the rural population of Southeast China and to explore the impacts of socioeconomic factors and heavy metal pollution in soil. Methods This study was conducted using the New Rural Cooperative Medical Scheme (NRCMS) claims data covering 20.9 million rural residents from 73 counties in Southeast China during 2015–2016. The associations between breast cancer hospitalization and socioeconomic factors and soil heavy metal pollutants were evaluated with quasi-Poisson regression models and geographically weighted Poisson regressions (GWPR). Results The annual hospitalization rate for breast cancer was 101.40/100,000 in the studied area and the rate varied across different counties. Overall, hospitalization for breast cancer was associated with road density (β = 0.43, P = 0.02), urbanization (β = 0.02, P = 0.002) and soil cadmium (Cd) pollution (β = 0.01, P = 0.02). In the GWPR model, a stronger spatial association of Cd, road density and breast cancer hospitalization was found in the northeast regions of the study area while breast cancer hospitalization was mainly related to urbanization in the western regions. Conclusions Soil Cd pollution, road density, and urbanization were associated with breast cancer hospitalization in different regions. Findings in this study might provide valuable information for healthcare policies and intervention strategies for breast cancer.

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Background Despite the known increasing incidence of breast cancer in China, evidence on the spatial pattern of hospitalization for breast cancer is scarce. This study aimed to describe the disparity of breast cancer hospitalization in Southeast China and to explore the impacts from socioeconomic factors and heavy metal pollution in soil. Methods This study was conducted using the New Rural Cooperative Medical Scheme (NRCMS) claims data covering 25.52 million female rural residents from 73 counties in Southeast China during 2015–2016. The associations between breast cancer hospitalization and socioeconomic factors and soil heavy metals pollutants were evaluated with quasi-Poisson regression models and geographically weighted Poisson regressions (GWPR). Results The annual hospitalization rate for breast cancer was 101.40/100,000 in the studied area and the rate varied across different counties. Overall, hospitalization for breast cancer was associated with road density (β = 0.43, P = 0.02), urbanization (β = 0.02, P = 0.002) and soil cadmium (Cd) pollution (β = 0.01, P = 0.02). In the GWPR model, a stronger spatial association of Cd, road density and breast cancer hospitalization was found in the northeast regions of the study area while breast cancer hospitalization was mainly related to urbanization in the western regions. Conclusions Soil Cd pollution, road density, and urbanization were associated with breast cancer hospitalization in different regions. Findings in this study might provide valuable information for healthcare policies and intervention strategies for breast cancer.

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