Patients with type 2 diabetes mellitus often face significant treatment burden, which substantially impacts their quality of life and health outcomes. Reducing treatment burden represents a critical component for improving patient prognosis and enhancing treatment adherence. Based on the cumulative complexity model, this article systematically examines the conceptual connotation and multidimensional characteristics of treatment burden in type 2 diabetes mellitus patients, explores the theoretical extension and application value of cumulative complexity model in the type 2 diabetes mellitus field, elucidates its specific applications and recent advances in treatment burden research, evaluates the limitations of existing assessment tools while proposing a multidimensional assessment framework, and ultimately develops cumulative complexity model based intervention strategies. The findings provide theoretical references for optimizing patient-centered diabetes management approaches and offer novel perspectives for treatment burden intervention.
ObjectiveTo analyze the trend of chronic kidney disease (CKD) disease burden attributable to metabolic factors in China from 1990 to 2021, and to predict the death of CKD due to metabolic factors in China from 2022 to 2046. MethodsBased on the 2021 Global Burden of Disease Database, this paper collected and sorted out the CKD deaths, disability-adjusted life years (DALYs), premature death lost life years (YLLs), and disability life lost years (YLDs) attributed to metabolic factors by different ages and sexes in China from 1990 to 2021, and used the Joinpoint regression model to systematically evaluate the temporal trends of standardized mortality and standardized DALYs rate. The age-period-cohort (APC) model was used to assess age, period, and cohort effects, and the R software Nordpred package was used to predict future changes in the burden of disease. ResultsCompared with 1990, the mortality rate, DALYs rate, YLLs rate, and YLDs rate attributable to metabolic factors of Chinese residents in 2021 showed an upward trend, and the characteristics of male higher than female, higher age group than lower age group. The primary metabolic factor influencing the disease burden of CKD was hyperglycemia. The results of Joinpoint analysis showed a downward trend in the standardized mortality and standardized DALYs rate of CKD attributed to metabolic factors. The results of age-period-cohort model analysis showed that the age effect of CKD attributed to metabolic factors increased significantly, the period effect increased slowly, and the cohort effect showed a downward trend. ConclusionThe disease burden of CKD attributed to metabolic factors in China is generally on the rise, and men, the elderly, and diabetic patients are the key focus of the disease.
Objective To analyze the basic characteristics of hospitalized patients with colorectal cancer (CRC), to estimate the hospitalization scale, medical resource utilization, and cross-regional hospitalization of CRC inpatients in Sichuan Province, which will provide data support for scientifically formulating colorectal cancer medical resource allocation measures. Methods Based on the hospital discharge records of CRC inpatients collected from secondary hospitals and tertiary hospitals in Sichuan Province between 2015 and 2019, descriptive statistical analysis was performed and the cross-geographical hospitalizations was visualized using a directed network. Results During the study period, the number of CRC inpatients and hospitalizations increased with time. The average age of CRC inpatients in 2019 was 65.1 years, an increase of 1.5 years in the 5-year-period. The proportion of men was relatively high (about 60.1%) and remained stable in the 5-year-period. The median length-of-stay of CRC inpatients per year was 25 days (IQR: 13 days, 45 days), and inpatients in urban areas were 2 days longer than that in rural areas. The median hospitalization cost of CRC inpatients per year was 32 900 yuan (IQR: 11 200 yuan, 59 300 yuan), men were 500 yuan higher than women, and patients in urban areas were 9 900 yuan higher than that in rural areas. From 2016 to 2019, 13.9% hospitalizations (59 512 hospitalizations) were cross-geographical hospitalizations, where Chengdu had the lowest outflow rate (1.0%) and the highest inflow rate (29.3%). Conclusions CRC inpatients showed an aging trend, and the number of hospitalizations and annual hospitalization costs increased year by year. Cross-geographical hospitalizations mainly flow to the provincial medical center and a small part flow to the regional medical centers.
ObjectiveTo analyze the latest epidemiological status of breast cancer in China, trends in morbidity and mortality from 1990 to 2019, and related prognostic risk factors.MethodsData on incidence and mortality of Chinese female breast cancer, their related age-standardized rates (ASRs) from 1990 to 2019, and attributable risk factors were obtained from the Global Burden of Disease (GBD) database, and data on disability-adjusted life years (DALYs) of 34 provinces in China were obtained from literature. Joinpoint regression analysis was used to analyze the trends of ASRs. The exposure levels of each attributable risk factor and the increased cancer burden were analyzed.ResultsThe incidence of breast cancer in Chinese females increased annually, from 17.07/100 000 in 1990 to 35.61/100 000 in 2019, while the mortality rate initially increased and decreased, and then exhibited an upward trend after 2016 and there was no obvious variation from 1990 (9.16/100 000) to 2019 (9.02/100 000). Among the 34 provinces of China, Shandong Province had the most serious breast cancer burden, while Macao Special Administrative Region had the lowest. Among the seven prognostic risk factors, high body mass index (BMI) contributed the most to the breast cancer burden and the exposure risk of a diet high in red meat had shown a significant increasing trend in the past 30 years. Therefore, the disease burden caused by a high red meat diet would be increasing.ConclusionsThe incidence rate of breast cancer in Chinese females is increasing. With the development of social economy and the change of people’s dietary habits, the breast cancer burden in China trends to become heavier and heavier. Therefore, it is necessary to conduct the "three early" prevention and treatment and advocate healthy and reasonable diet and living habits to reduce the burden of breast cancer to improve prognosis and quality of life.
Objective To systematically review the incidence, mortality and disease burden of stroke in China. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Embase, Web of Science and Cochrane Library databases were electronically searched to collect cohort studies on stroke epidemiology and disease burden from inception to June 30, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 18.0 software. Results A total of 49 studies were included, and the results showed that the overall incidence of stroke in China was 430/100 000 (95%CI 370/100 000 to 490/100 000); The incidence of stroke in men was 510/100 000 (95%CI 450/100 000 to 580/100 000); The incidence of stroke in women was 370/100 000 (95%CI 320/100 000 to 410/100 000). The overall mortality rate of stroke in China was 220/100 000 (95%CI 160/100 000 to 280/100 000); Stroke mortality in men was 160/100 000 (95%CI 120/100 000 to 190/100 000); Stroke mortality in women was 130/100 000 (95%CI 100/100 000 to 160/100 000). The average standard DALY rate of stroke in China was 2 238.09/100 000, and men (3 510.53/100 000) was higher than that of women (2 083.39/100 000). Conclusion The risk of stroke in men in China is significantly higher than that in women, which is mainly attributed to the higher rate of smoking and drinking alcohol, poor eating habits and the neglect of health management. Moreover, interregional differences in aging, especially the higher aging levels in the eastern and northern regions, also have a significant impact on stroke incidence in these regions.
Objectives To investigate the economic burden of percutaneous endoscopic gastrostomy (PEG) in hospitalized patients with amyotrophic lateral sclerosis (ALS) and analyze its influencing factors. Methods Clinical data of ALS patients who underwent PEG between 2014 and 2024 were collected through the inpatient electronic medical record system of West China Hospital of Sichuan University (including age, gender, comorbidities, disease course, daily living abilities, length of hospital stay, hospitalization costs, etc.), and their impact on the total hospitalization expenses were studied. Results A total of 102 patients were included. The median total hospitalization cost for ALS patients undergoing PEG was 12 701.00 (10 412.75, 16 720.00) yuan. The results of multiple linear regression analysis showed that the length of hospital stay and age of patients could affect the total hospitalization cost. Conclusions The total medical expenses for ALS patients undergoing PEG are approximately 10 000 yuan. Early assessment of the disease status in ALS patients, providing individualized management, and optimizing treatment plans to reduce hospital stay and medication costs can effectively control medical expenses.
ObjectiveTo analyze the disease burden and temporal trends of chronic obstructive pulmonary disease (COPD) attributable to air pollution in China from 1990 to 2021. MethodsUtilizing data from the Global Burden of Disease Study 2021 (GBD 2021), we assessed the burden of COPD attributable to air pollution in China through metrics including death counts, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), age-standardized DALY rate (ASDR), annual percentage change (APC), and average annual percentage change (AAPC). A Bayesian Age-Period-Cohort (BAPC) model was employed to project future trends in COPD burden attributable to air pollution. ResultsIn 2021, China’s ASMR and ASDR for COPD attributable to air pollution were 32.57 and 533.84 per 100,000 population, respectively, exceeding global averages. From 1990 to 2021, both ASMR and ASDR exhibited significant declining trends, with AAPCs of −5.24% (95% CI −5.78% to −4.70%) and −5.28% (95% CI −5.75% to −4.81%), respectively. The burden intensified with advancing age and was disproportionately higher among males compared to females. BAPC projections indicate a continued decline in COPD burden from 2022 to 2035, with ASMR expected to decrease from 56.40 to 23.02 per 100,000 and ASDR from 900.14 to 408.64 per 100,000. Conclusion Despite sustained reductions in the burden of COPD attributable to air pollution in China from 1990 to 2021, with further declines anticipated through 2035, national rates remain elevated relative to global benchmarks. Male and elderly populations bear the highest burden, underscoring the urgency for targeted interventions to mitigate air pollution exposure and address health disparities in vulnerable demographics.
ObjectiveTo investigate the epidemiological and economic burden of acute meningitis and encephalitis syndrome (AMES) in Jinan, so as to provide references for prevention and control of AMES. MethodsThe monitoring data of the AMES Special Reporting System of Jinan City from 2007 to 2014 was collected and the epidemiological characteristics of AMES were analyzed. A questionnaire survey was performed in AMES patients reported in 2013 to collect the basic information, prognosis, medical and non-medical expenses etc. of patients. The DALYs and economic burden of AMES were estimated by using SPSS 13.0 software. ResultsThe average incidence rate of AMES in Jinan was 8.49/100 000 through 2007 to 2014 and the mortality was 4.96‰. The total DALYs were 36 659.51 and the average DALY was 8.27.77.86% were aged less than 14 years old. The average direct economic burden of each case was 19.5 thousand RMB and the average indirect economic burden caused by DALYs was 69.1 thousand RMB. ConclusionThere's heavy burden from AMES, and measures should be made to reduce the incidence and economic burden.
Objective To explore the burden situation among caregivers of stroke survivors, and analyze the association between burden and the quality of life among caregivers. Method In this cross-sectional study, a total of 230 stroke survivor-caregivers were investigated with basic demographic information, Zarit Burden Interview (ZBI) and the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-BREF) from May 2015 to November 2015. Results The mean age of the caregivers of stroke survivors was (66.7±11.7) years, and the caregiver burden was in the mild level with the mean ZBI score of 21.11±6.96. The multiple linear regression analysis showed that the influencing factors of caregiver burden were the complications, self-care ability, residence of stroke survivors, and the self-rating health status of caregivers (P<0.05). And the total ZBI score was negatively correlated with the total WHOQOL-BREF scores (P<0.01), physiological dimensional scores (P<0.01), social dimensional scores (P<0.01), and environmental dimensional scores of caregivers (P<0.01). Conclusions The caregivers of stroke survivors suffer from general caregiver burden, and the heavier caregiver burden is, the poorer the quality of life of the caregivers is. According to the different conditions between urban and rural areas of China, it is reasonable to formulate a targeted program with the consideration of requirements referring to stroke survivors and their caregivers. It should involve physiological, psychological, social, environmental factors and so on to improve the caregivers’ quality of life finally.
ObjectiveTo investigate the current status of symptom burden and psychological distress among lung cancer patients in the diagnostic phase, and to explore the chain mediating role of social support and resilience between symptom burden and psychological distress. MethodsThe patients with lung cancer in the diagnostic phase who were treated in the Department of Thoracic Surgery of the Second Xiangya Hospital of Central South University from October 2022 to June 2023 were investigated by a general information questionnaire using the MD Anderson Symptom Inventory, the Social Support Rating Scale, the Connor-Davidson Resilience Scale, and the Distress Thermometer. The chain mediating role of social support and resilience between symptom burden and psychological distress was analyzed. ResultsA total of 413 lung cancer patients were enrolled, including 173 males and 240 females, aged (54.69±10.82) years. The detection rate of psychological distress among lung cancer patients in the diagnostic phase was 48.18%, and the average score was (3.84±2.50) points. Psychological distress was positively correlated with symptom burden (P<0.01), and negatively correlated with social support and resilience (P<0.01). The mediating effect of resilience between symptom burden and psychological distress was significant. The chain mediating effect of social support and resilience between symptom burden and psychological distress was also significant. ConclusionLung cancer patients in the diagnostic phase have a high detection rate of psychological distress. Symptom burden can directly impact psychological distress, and can affect psychological distress through the indirect path of resilience as well as the chain mediating path between social support and resilience among lung cancer patients in the diagnostic phase.