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Background: With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies. Objective: This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS. Methods: A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute. Results: The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them. Conclusion: The chronic disease patients' preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients' demand in different regions. [ABSTRACT FROM AUTHOR]

Background: Primary health-care workers (PHWs) managed increased workloads and pressure during the COVID-19 pandemic. This study conducted a national survey examining burnout among PHWs at the end of the COVID-19 pandemic, and identifies related factors. By doing so, it addresses the gap in understanding the burnout situation among PHWs at a national level, taking into account urban-rural disparities. Methods: We conducted a nationwide cross-sectional survey of PHWs in China from May to October 2022, covering 31 provinces. The MBI-HSS was used to measure overall burnout and emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). We used multivariable logistic regression to identify risk factors, and subgroup analyses to identify differences between rural and urban areas. Results: 3769 PHWs from 44 primary health-care institutions completed the survey. Overall, 16.6% reported overall burnout, and the prevalence of EE, DP, and reduced PA was 29.7%, 28.0%, and 62.9%, respectively. The prevalence of overall burnout (17.6% vs. 13.7%, P = 0.004) and EE (31.5% vs. 24.8%, P < 0.001) was higher in urban than rural areas (AOR = 1.285; 95%CI, 1.021–1.617). Job satisfaction was a protective factor against burnout in both settings. The protective factors of overall burnout, EE and DP vary between urban and rural areas. Conclusions: The Mental Health Status Questionnaire-Short Form (MSQ-SF) score functioned as a protective factor against burnout across both rural and urban locales, highlighting the intrinsic link between job satisfaction and burnout. Other influencing factors differed between urban and rural areas, so interventions should be tailored to local conditions. Rural married PHWs experienced the lower prevalence of burnout indicates the support structure may play a significant role. In urban settings, it is recommended to strategically pre-emptively stock essential supplies like PPE. [ABSTRACT FROM AUTHOR]

This study investigates the spatiotemporal variations in ambulance demand in southern Sweden, and how land use factors and sociodemographic factors are associated with variations in demand. A standardized ambulance demand ratio (SADR) indicating whether the risk of requiring an ambulance exceeded the expected was calculated using ambulance dispatch data in southern Sweden in 2018. Spatial analysis using a geographic information system (GIS) and spatial statistical methods underlie the methodology. Findings show that although rural areas are associated with a higher risk of requiring an ambulance (especially in daytime), this risk may be obscured by the more numerous dispatches occurring in urban areas. The increased risk in areas with bars and nightclubs, schools, industrial areas or road crossings reflects temporal variations in people's routine activities. By dictating how and when population's reshuffle, land use factors can help explain variations in risk for requiring an ambulance. Confirming previous research, areas with a higher share of older adults are associated with a higher ambulance demand while areas with a high median income are associated with lower demand. Population size may be an inadequate indicator of ambulance demand. Planning should account for daily changes in population sizes and compositions as this impacts ambulance demand. [ABSTRACT FROM AUTHOR]

• This study analyzes the relationship between Internet use and physical activity for family caregivers of older adults. • Internet use was negatively associated with MVPA while had no correlation with LPA. • The relationship between Internet use and MVPA was mediated by participation in economic activities, while participation in social activities acted as a suppressor. • The association between Internet use and MVPA was only reported in rural family caregivers. This study examined the influence of Internet use on light-intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) among family caregivers of older adults, utilizing data from the 2018 China Health and Retirement Longitudinal Study (N = 3,194). The Tobit model and Propensity Score Matching were first used to test the focal associations. Subsequently, mediation analyses and heterogeneity analysis were conducted to explore the pathways and urban-rural disparities. The results indicated that Internet use was negatively associated with MVPA and was not correlated with LPA. The Internet use – MVPA relationship was mediated by participation in economic activities, while participation in social activities acted as a suppressor. Further, the focal association was only found in rural family caregivers. The findings suggest that effective health promotion interventions are needed to mitigate the negative influence of Internet use on the MVPA of family caregivers of older adults, especially for those in the rural. [ABSTRACT FROM AUTHOR]

Home- and community-based services (HCBS) are optimal ways to deal with disability problems among older adults. This study aims to analyze urban–rural disparities in the relationship between HCBS utilization and levels of disability among Chinese older adults with disabilities, so as to meet the long-term care needs of them. In applying the Andersen Behavioral Model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey (CLASS). After adjusting covariates, disability levels among Chinese older adults with disabilities were significantly correlated with HCBS utilization in urban areas but not in rural areas. The urban–rural disparities may be due to the low utilization of HCBS in rural areas (only 11.2%) among older adults with disabilities compared with their urban counterparts (22.7%). [ABSTRACT FROM AUTHOR]

Abstract Background With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies. Objective This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS. Methods A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute. Results The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them. Conclusion The chronic disease patients’ preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients’ demand in different regions.

Abstract Background Primary health-care workers (PHWs) managed increased workloads and pressure during the COVID-19 pandemic. This study conducted a national survey examining burnout among PHWs at the end of the COVID-19 pandemic, and identifies related factors. By doing so, it addresses the gap in understanding the burnout situation among PHWs at a national level, taking into account urban-rural disparities. Methods We conducted a nationwide cross-sectional survey of PHWs in China from May to October 2022, covering 31 provinces. The MBI-HSS was used to measure overall burnout and emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). We used multivariable logistic regression to identify risk factors, and subgroup analyses to identify differences between rural and urban areas. Results 3769 PHWs from 44 primary health-care institutions completed the survey. Overall, 16.6% reported overall burnout, and the prevalence of EE, DP, and reduced PA was 29.7%, 28.0%, and 62.9%, respectively. The prevalence of overall burnout (17.6% vs. 13.7%, P = 0.004) and EE (31.5% vs. 24.8%, P

This investigation aims to determine the impact of public investment in the digital economy on de-urbanization in Pakistan. Using secondary data, the researcher employed a quantitative research design to analyze various data related to the variables of interest, most notably the digital infrastructure score, internet penetration rate, GDP growth rate, employment rate, education level, and health index score. The process begins with brief descriptive findings indicating substantial investment discrepancies and digital infrastructure quality differences between rural and urban populations, with the urban population receiving much more investment on average. The comparative findings underscore the significant investment disparity, while the regression results demonstrate a positive correlation between the rate of internet penetration and GDP growth. The other variables, such as the digital infrastructure score, the afore-mentioned employment and education variables, and the health index, are all non-significant in the model. More investment appears necessary to reap such economic benefits, and the aforementioned complementary policies will be required to facilitate rural broadband access. Collectively, the results of this research will help policymakers further a more inclusive approach to economic policy and create conditions for sustainable development regardless of population density. [ABSTRACT FROM AUTHOR]

• Strong association between gerontechnology Acceptance, acceptance of Change, and mental Wellbeing: the study found a significant relationship between gerontechnology acceptance, acceptance of change, and mental wellbeing among older adults. • Acceptance of change as a Mediator: acceptance of change was identified as a mediator in the relationship between gerontechnology acceptance and mental wellbeing. This suggests that a positive attitude towards change can enhance mental wellbeing through technology acceptance. • Lower resistance to change linked to higher mental Wellbeing: higher levels of gerontechnology acceptance were associated with lower levels of resistance to change, which in turn were linked to higher levels of mental wellbeing among older adults. • Importance of fostering a positive attitude towards Change: the findings highlight the importance of fostering a positive attitude towards change in older adults to enhance their mental wellbeing, particularly in the context of technology acceptance. • Recognition of urban–rural Disparities: the study acknowledges the potential disparities between urban and rural areas in terms of gerontechnology acceptance and mental wellbeing. This underscores the need for context-specific interventions. • Implications for intervention Strategies: the findings suggest that interventions aimed at promoting positive attitudes towards technology and change could enhance the well-being of older adults. This includes targeted educational campaigns, building social support systems, and improving accessibility and affordability of technology. The global aging population necessitates leveraging technology for older adults' independence and mental well-being. Gerontechnology, tailored for older users, thrives when accessible and accepted, with the pivotal role of acceptance of change shaping its adoption. This study investigates the mediating role of acceptance of change in the relationship between gerontechnology acceptance and mental well-being among older adults and explores disparities in urban and rural settings A cross-sectional, correlational design adhering to STROBE guidelines collected data through an interview survey from 802 older adults. Instruments included the Older Adult Structured Survey, Short Version of Senior Technology Acceptance, Acceptance of Change Scale, and the World Health Organization Well-Being Index. The results underscore a significant correlation between technology adoption, adaptability, and mental well-being among 60-year-olds and older. Notably, an individual's openness to change significantly influences the technology-mental well-being relationship, emphasizing its impact on overall health. Urban areas exhibit a stronger positive correlation between technology acceptance and mental well-being, whereas rural regions demonstrate a more pronounced negative correlation. This research contributes valuable knowledge for addressing the unique challenges older adults face in diverse geographic settings, paving the way for targeted and effective initiatives. Nurses should prioritize understanding the nexus between gerontechnology acceptance, change adaptability, and mental wellness, integrating technology education and culturally sensitive interventions to enhance care strategies for older adults in diverse geographic settings. This study lays the groundwork for developing person-centered geriatric nursing care plans, underscoring the importance of harnessing technology for improved mental well-being. [ABSTRACT FROM AUTHOR]

Due to the growing importance of accessibility to urban amenities on quality of life and neighborhood satisfaction in South Korea, various efforts have been made to improve accessibility to urban amenities by establishing a minimum standard, an approach called Living Social Overhead Capital (Living SOC); for example, one such standards states that an elementary school should be reachable within a 15-min walk. However, these endeavors have not yet resulted in an equal distribution of Living SOC in urban and rural areas. Many residents feel the disparity of Living SOC is greatest in areas where the rural city was incorporated into an adjacent urban city—often called an integrated urban–rural city—or when new towns were developed in rural cities. This situation can lead to the creation of dissimilar landscapes and infrastructure within a single city. As such, this research observes how the resultant disparity in proximity between urban and rural areas impacts neighborhood satisfaction, as reflected in housing prices. The outcomes indicate that, with the exception of senior care and education, all observed amenities were found to be located closer to residences in urban areas. Additionally, the closer the Living SOC, the higher the housing prices. The findings of this study posit an urgent need for a comprehensive Living SOC plan for entire cities, not only for newly developed areas, to avoid widening the existing gap between urban and rural Living SOC. [ABSTRACT FROM AUTHOR]

BackgroundThe double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure.MethodsThis study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010–2011 and 2015, which provided information on women’s and children’s health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010–2011 and 2015.ResultsThe average age of mothers was approximately 31 years, and children’s ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women.ConclusionThe growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban–rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO’s Double Duty Actions, are essential to improve the nutritional health of Zimbabwe’s population.

Purpose: Rural cancer survivors in the United States, compared to urban survivors, face greater cancer mortality and poorer health. To better understand cancer health disparities, this study examined differences in lifestyle behaviors, healthcare access, and psychological distress between rural and urban survivors.Methods: Rural (n = 188) and urban (n = 242) survivors from a cancer center’s catchment area in the United States mid-Atlantic region completed a survey. Regression models were used to examine the association between rural-urban residency, lifestyle behaviors, healthcare access, and psychological distress, controlling for covariates.Results: After adjusting for age, gender, race, education, and distance (in minutes) to the closest healthcare facility, rural survivors remained more likely to have obesity (OR = 1.95, p = .005), less likely to consume alcohol (OR = 0.48, p = .002), and more likely to find it somewhat hard to get to a hospital (OR = 2.52, p

When compared to their urban counterparts, rural regions have worse health outcomes and more challenges in health care access. As the only island state in the US, Hawai'i's unique geographic layout may magnify these disparities. However, there are limited publications on the impact of urban-rural disparities in health care in Hawai'i. The study team aimed to identify the challenges rural health care providers face when managing treatment of Parkinson's disease (PD), a complex disease. A self-administered survey was sent to 247 eligible providers who practiced in Hawai'i and prescribed PD medications from 2017-2019. The survey assessed: provider's comfort level in PD management; utilization and accessibility of health care services; perspective on barriers to PD care; and perspective on telemedicine. Providers were categorized into O'ahu providers (OP, urban) and neighbor island (Hawai'i, Kaua'i, and Maui) providers (NIP, rural). The final sample size was 44 providers (18% response rate). NIP were significantly less likely than OP to report access to social workers (P=.025), geriatric services (P=.001), and psychologist/psychiatrist/mental health professionals (P=.009). There were no statistical differences in: criteria used for PD diagnosis, resources utilized for PD education, and comfort in prescribing PD medications. The findings show that NIP are just as engaged and capable in providing PD care as OP. However, NIP encounter more limitations to accessibility, which can affect the quality of PD care that their rural patients receive. Further research is needed to understand how these limitations affect health-related outcomes in PD as well as other chronic diseases. [ABSTRACT FROM AUTHOR]

This study analyses the evolution of the main indicators of students’ high school performance at the high school graduation exams (Romanian Baccalaureate) from a geographical perspective. Both participation and pass rates fluctuate depending on the type of high school, gender and place of residence. Behind these quantifiable characteristics there are significant disparities in (in)equality of educational opportunities influenced by the questionable efficiency of the education system in providing quality education to every student, regardless of their parents’ financial background. Although the upper cycle of secondary school (11-12th grades) is not legally compulsory, successful graduation is essential for the economic, social and cultural insertion of the future adults in a functioning society. The lack of performance of some high schools and vulnerable groups of students, who face problems of accessibility, motivation, opportunity, and financial support, as well as the worrying numbers of exam absentees, must be brought baccalaureate to the permanent agenda of the policy makers, not exclusively during the exam period. The complexity of the official data from 2015-2022 has allowed the geostatistical analysis of school performance, highlighting the deep discrepancies within the system, specifically between urban and rural students, the administrative and economic hierarchy of the locality and the prestige of the high school attended. The insights of this analysis can be used to identify optimal solutions to enhance the research about educational disparities. [ABSTRACT FROM AUTHOR]

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IntroductionThe digital financial inclusion (DFI) provides opportunities to improve the relative capacity to pay for healthcare services by rural residents who are usually underserved by traditional finance in China. This paper provides empirical evidence on how the development of DFI affects the healthcare expenditure disparities between urban and rural residents.MethodsWe employed the fixed effects model and instrumental variable method to estimate the impact of DFI on the Theil index of urban–rural disparities in healthcare expenditures, using panel data from 31 provinces (2011 ~ 2020) in China. We further adopted a moderating effect model to test whether the intensity of the impact would vary depending on the level of local government health expenditures.ResultsThe results suggest a negative association between the development level of DFI and the urban–rural healthcare expenditure disparities in China. For every 1% increase in the DFI index, the Theil index of urban–rural disparities in healthcare expenditures would fall by 0.0013. After changing the measurement method for the dependent variable and adjusting the sample, the results remain robust. Moreover, the result of the moderating effect model indicates that, a high level of government health expenditures is conducive to the impact of DFI.DiscussionOur research reveals that DFI plays an important role in bridging the urban–rural gap in healthcare expenditures. This finding provides new information for addressing the issue of urban–rural healthcare inequality in China. Chinese government needs to accelerate the construction of digital infrastructure and increase the penetration rate of digital tools in rural areas to promote the beneficial effects of DFI. Additionally, it is also necessary for local government to address the unbalanced allocation of medical resources between urban and rural areas, especially the shortage of rural human resources.

There has been an increased concern on indoor air quality (IAQ) in residences since the majority of individuals’ time is mainly spent indoors. We inspected and measured indoor environmental parameters in 399 homes in northeast China in order to study IAQ. We systematically measured multilevel environmental parameters (physical, chemical, and biological) in children’s bedrooms during all seasons. The results indicated that the median values for indoor temperature, relative humidity, total volatile organic compounds (TVOC), and formaldehyde concentrations throughout the year were within the Chinese national standards. However, the median carbon dioxide concentrations exceeded 1000 ppm during spring, autumn, and winter. In the same seasons, the air change rate (ACR) was below the minimum required level of 0.5 h−1. Di-2-ethylhexyl phthalate (DEHP), di-n-butyl phthalate (DnBP), and di-isobutyl phthalate (DiBP) were predominantly detected in settled dust, displaying median concentrations of 126.9, 41.5, and 16.3 μg/g, respectively. Notably, phthalate concentrations were significantly higher in urban houses as compared to rural houses. Furthermore, median concentrations of Dermatophagoides farinae (Der f) and endotoxin were 689.4 ng/g and 3689.1 EU/g, respectively, trending higher in winter than summer. There was a negative correlation between ACR and chemical pollutants (TVOC, formaldehyde, and DiBP). In conclusion, northeast Chinese homes had poor indoor air quality with ubiquitous exposure to modern chemical compounds and insufficient ventilation.

Tropical cyclone (TC) peripheral downdrafts and urbanization can promote extreme heatwave (HW) events in the Greater Bay Area (GBA), a highly urbanized coastal area in China. However, the roles of synoptic patterns and urbanization in the HW events remain unclear, particularly for the joint occurrences of the tropical cyclone and heatwave (TC-HW) extremes. Here, we identify three synoptic patterns closely related to TC-HW events, namely: the northeastern Taiwan TC pattern (P4), the southeastern Taiwan TC pattern (P6), and the eastern Taiwan-Philippine Sea TC pattern (P7), as these patterns could enhance HWs through strong downdrafts, strong solar radiation, and low humidity, thereby favoring the maintenance of TC-HW events. Among the three patterns, P6 is most conducive to the occurrence of TC-HW compound events in the GBA. Moreover, the urban-rural temperature disparities under the TC-HW events are unique than those on the days without TC-HW events, i.e., the daily maximum temperature at rural and suburban stations is higher than that at urban stations. This unique feature is the opposite of the urban heat island and is mainly attributed to the rural subsidence warming induced by the TCs and Foehn effects. These results indicate that the spatial distribution of HW in coastal area is substantially modulated by TCs, which is meaningful to understanding the features and underlying mechanism of compound TC-HW events and adapting to their impacts.

Abstract Background Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban–rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban–rural disparities in the economic burden attributed to NO2 and the explanation for the disparities. Methods Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden. Results For every 10-μg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban–rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 μg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services. Conclusions Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban–rural differences in socioeconomic status and medical resources contributed to the urban–rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously.

Background: Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban–rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban–rural disparities in the economic burden attributed to NO2 and the explanation for the disparities. Methods: Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden. Results: For every 10-μg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban–rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 μg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services. Conclusions: Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban–rural differences in socioeconomic status and medical resources contributed to the urban–rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously. [ABSTRACT FROM AUTHOR]

Suicide is among the leading causes of death and rates have been steadily increasing over the past two decades in the United States. The COVID-19 pandemic has given rise to a phenomenon known as the “honeymoon effect” which has led to fluctuations in the suicide rate, and this emphasizes the need for continued research to inform targeted interventions. In our study, we investigate changes in the suicide rate from 2017 to 2021 for different classifications of counties. We find that the suicide rate first decreased during the early years of covid, and then slowly increased. Suicide rates are higher in the west relative to the rates in the middle and eastern parts of the United States. Urban areas exhibit rates that follow the national pattern, while rates in rural areas have continued to increase from 2017 to 2021. Moreover, the suicide rate has continued to increase in counties recording population loss, and counties that have their economy focused on mining, Federal/State government, and the recreation industry. There was an initial decrease followed by an increase in counties considered as retirement destinations, and counties having persistent poverty, persistent child poverty, and low employment. These changes in suicide patterns noted from 2017 to 2021 show the continuous need to understand the importance of geographic context and its relationship with potential increases in the odds for suicide. [ABSTRACT FROM AUTHOR]

Abstract Background Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them. Methods The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services. Results Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49–0.85; P

Background: Basic public health services for diabetes play an essential role in controlling glycemia in patients with diabetes. This study was conducted to understand the urban-rural disparities in the utilization of basic public health services for people with diabetes and the factors influencing them. Methods: The data were obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS) with 2976 diabetes patients. Chi-square tests were used to examine the disparities in the utilization of diabetes physical examination and health education between urban and rural areas. Logistic regression was performed to explore the factors associated with the utilization of diabetes public health services. Results: Among all participants, 8.4% used diabetes physical examination in the past year, and 28.4% used diabetes health education services. A significant association with age (OR = 0.64, 95% CI:0.49–0.85; P < 0.05) was found between patients' use of health education services. Compared with diabetes patients living in an urban area, diabetes patients living in a rural area used less diabetes health education. (χ2= 92.39, P < 0.05). Patients' self-reported health status (OR = 2.04, CI:1.24–3.35; P < 0.05) and the use of glucose control (OR = 9.33, CI:6.61–13.16; P < 0.05) were significantly positively associated with the utilization of diabetes physical examination. Patients with higher education levels were more likely to use various kinds of health education services than their peers with lower education levels (OR = 1.64, CI:1.21–2.22; P < 0.05). Conclusion: Overall, urban-rural disparities in the utilization of public health services existed. Vulnerable with diabetes, such as those in rural areas, are less available to use diabetes public health services. Providing convenient health service infrastructure facilitates the utilization of basic public health services for diabetes in older patients with diabetes, especially in rural areas. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the factors influencing household financial choices in Malawi. The authors also compare how household financial decisions differ in urban and rural areas. Design/methodology/approach: The authors utilize the logit model to examine the factors that influence household financial decisions using the Malawi Integrated Household Survey 2019–20, while Oaxaca–Blinder decomposition is used to estimate the variations in household financial decisions between urban and rural areas. Findings: The authors find that the likelihood of saving increases with income, secondary and tertiary education, and age. The likelihood of saving also decreases with household size and remittances. Additionally, the authors report that marriage reduces the likelihood of loans, whereas sex, age, and income raise the likelihood of loans. According to this study's findings, income discrepancies between urban and rural samples account for most observed household financial variations. The authors also find that most of the observed variations in household financial decision-making between urban and rural households are reduced when income equality, participation in agriculture, university education, and household size are considered. Originality/value: Using data from the Malawi Integrated Household Survey 2019–20, this research analyzes the components that affect household financial decisions. While most studies only look at one component of household finances, this study concurrently addresses debt and savings. The study also evaluates whether changes in the variables between urban and rural households impact those households' financing choices. [ABSTRACT FROM AUTHOR]

Abstract Background Understanding nutritional status among women of childbearing age (WCA) is of increasing concern, as nutrient intakes may affect the health of WCA and well-being of their offspring. This study aimed to investigate secular trends of dietary energy and macronutrients intakes and access longitudinally the urban-rural and geographic disparities among Chinese WCA. Methods A total of 10,219 participants were involved in three rounds of the Chinese Health and Nutrition Survey (CHNS:1991, 2004, and 2015). Average macronutrients intakes were compared against the Chinese Dietary Reference Intakes Standard (DRIs) to better assess adequacy. Mixed effect models were used to estimate the secular trends of dietary intake. Results A total of 10,219 participants were involved. Dietary fat, the percentage of energy (%E) from fat, and the proportion with more than 30% of energy from fat and less than 50% from carbohydrates increased notably over time (p

As the world's most populous country, China's energy poverty reduction achievements directly impact the global energy poverty reduction process. Analyzing energy poverty in China is therefore critical to consolidating the results of poverty eradication, eliminating relative poverty, and improving the social welfare of residents. However, prior research neither considered the applicability of existing energy poverty indicators to the current Chinese reality, nor the spatiotemporal disparities of energy poverty using micro-level data. To study the dynamics of energy poverty in China at the household level, a new multidimensional energy poverty index is constructed with seven dimensions using multiple correspondence analysis methods. Furthermore, provincial disparities and characteristics of energy poverty are compared using a spatial autocorrelation analysis method. The findings show that energy poverty has improved in China from 2012 to 2018, but its incidence and intensity remain high. Moreover, significant regional differences in energy poverty exist between different regions of China. High levels of energy poverty are mainly concentrated in the western and northeastern regions (especially in rural areas), and the urban–rural gap shows a similar pattern. The results obtained from spatial autocorrelation analysis demonstrate that China's energy poverty exhibits significant spatial clustering characteristics. Further, the results of standard deviation ellipse show that during the study period, the center of gravity of energy poverty in China was in Henan province and gradually shifted to the northwest. These findings help policymakers to formulate specific energy poverty reduction policies for various groups affected by energy poverty. [ABSTRACT FROM AUTHOR]

This paper attempts to investigate the opposing trends in Chinese urban and rural household savings rates observed in the micro data during the period 1995-2013. Using the Chinese Household Income Project Survey (CHIPS) data, we find that the average urban household savings rate has consistently risen while the average rural household savings rate has gone the opposite direction during the same period. Using a variant of Deaton-Paxson decomposition analysis, we find that urban and rural households displayed vastly different life-cycle savings rate profiles. Results from the median regression and Oaxaca–Blinder decomposition suggest that the increasing urban savings rate can be explained by the continuously rising household income and increased precautionary savings for health shocks, whereas the shifts in household characteristics examined were not able to account for the decrease in rural household savings rate. The urban-rural savings disparities can be fully explained by the urban-rural income gap. [ABSTRACT FROM AUTHOR]

Due to the rapid innovative applications of technological education as a result of the swift development and popularity of telecommunication and wireless technologies, ever-more diversified methods of technological education play a critical role in various education and lecturing activities, without time and distance restrictions. Currently, in order to bridge the urban–rural development gap, the Taiwanese Government has introduced a lot of policies to encourage teenagers to return their hometowns; however, these policies have not achieved their goals, as the most of Taiwanese community development associations faced scarcities of professional knowledge without any educational support during the development of their various schemes, such as economic development, environmental protection, cultural heritage, public services, etc. As a result, local development depends on entire community development associations, especially in the most mountain regions of Taiwan. Moreover, community development associations have a lot of social responsibilities, such as age-related caring activities, driving local economies and industrial development, environmental protection and education, maintaining and developing traditional cultures and arts, etc. Due to the digital characteristics of technological education, most Taiwanese rural community development associations are able to obtain professional information and data about courses without space and time restrictions. Thus, after strengthening and satisfying professionals' demands, local economies will achieve growth and, therefore, younger persons would be encouraged to stay their original area, thus stimulating the development of rural community development associations. Eventually, the positive development cycle is predicted to increased and, as a result, the urban–rural disparities will be directly diminished by the diversified application of technological education in Taiwan. [ABSTRACT FROM AUTHOR]

Food waste has become a pressing global issue in recent years. In China, the issue of food waste has become increasingly severe. As a provincial capital city, Harbin is also a major agricultural city in China with distinct urban and rural features. This paper uses Harbin as a case study to evaluate different strategies for preventing and reducing food waste based on these urban–rural differences. This research is based on official data on household food waste in urban and rural areas of Harbin, as well as data collected from 333 telephone surveys through stratified random sampling. Independent t-tests, one-way analysis of variance (ANOVA), and logistic regression analysis were used to analyze the survey data, followed by a review of existing food waste policies and strategies. Our findings show that Harbin has had a positive response in adhering to national anti-food waste policies. However, its implementation has not been effective. There is a continuous increase in food waste generation. Moreover, gender, level of education, and household annual income have a significant impact on residents' food waste habits and there are significant differences between urban and rural areas in terms of "eating out" and "ordering food ingredients". The average daily amount of food waste generated by urban households is 3216.31 g, which is 2.4 times that of rural households. There are also differences in the causes of food waste between urban and rural residents due to different diets and eating habits. As a result, feasible and effective policy recommendations have been proposed to reduce food waste in response to these urban–rural differences. [ABSTRACT FROM AUTHOR]

Background: Few studies have provided observational data on long-term trends in the incidence of stroke and its subtypes, and shown the urban–rural disparities of stroke incidence in Japan. Methods: A multiple-source, community-based stroke surveillance was performed since 1963/1964 to determine all first-ever stroke cases among Japanese residents aged ⩾40 years living in the Minami-Takayasu district in Yao city, an urban community, and Ikawa town, a rural community. Sex-specific, age-standardized incidence per 1000/year with 95% confidence intervals was calculated during seven periods of 1963/1964–1971 (urban population (% men): 3242 (47.3%); rural population (% men): 2311 (46.0%)), 1972–1979, 1980–1987, 1988–1995, 1996–2003, 2004–2011, and 2012–2018 (13,307 (46.7%); 3586 (44.8%)). Results: The age-standardized incidence of all strokes in the Japanese urban community decreased from 6.60 to 1.15 per 1000/year for men and 3.28 to 0.59 for women. In the rural community, the corresponding incidence decreased from 11.51 to 1.98 for men and 6.46 to 1.31 for women. Similar reductions were observed in the incidence of intracerebral hemorrhage, subarachnoid hemorrhage, ischemic stroke, and lacunar stroke. In the period of 2012–2018, the incidence ratios (95% confidence intervals) of all strokes for the rural compared to the urban community were 1.72 (1.08–2.75) for men and 2.23 (1.23–4.03) for women. Conclusion: The stroke incidence continued to decline in both urban and rural Japanese communities with the regional disparities over the past half century, whereas it remained higher than that in many Western countries. [ABSTRACT FROM AUTHOR]

Background: Understanding nutritional status among women of childbearing age (WCA) is of increasing concern, as nutrient intakes may affect the health of WCA and well-being of their offspring. This study aimed to investigate secular trends of dietary energy and macronutrients intakes and access longitudinally the urban-rural and geographic disparities among Chinese WCA. Methods: A total of 10,219 participants were involved in three rounds of the Chinese Health and Nutrition Survey (CHNS:1991, 2004, and 2015). Average macronutrients intakes were compared against the Chinese Dietary Reference Intakes Standard (DRIs) to better assess adequacy. Mixed effect models were used to estimate the secular trends of dietary intake. Results: A total of 10,219 participants were involved. Dietary fat, the percentage of energy (%E) from fat, and the proportion with more than 30% of energy from fat and less than 50% from carbohydrates increased notably over time (p < 0.001). In 2015, urban western WCA had the most dietary fat (89.5 g/d), %E from fat (41.4%), with the highest proportion of energy from fat (81.7%) and carbohydrate (72.1%) out the range of DRIs. From 1991 to 2015, the average urban-rural differences in dietary fat decreased from 15.7 g/d to 3.2 g/d among eastern WCA. However, it increased to 16.4 g/d and 6.3 g/d among central and western WCA, respectively. Conclusion: WCA was experiencing a rapid transformation to a high-fat diet. Temporal variation with obvious urban-rural and geographic disparities in dietary. energy and macronutrient composition persistently existed among Chinese WCA.These findings have implications of future public strategies to strengthen the nutrition propaganda and education of balanced diet for WCA to help them to improve their nutritional status, especially for those living in western China. [ABSTRACT FROM AUTHOR]

• Children in rural areas have similar early learning opportunities, regardless of whether they live with both parents or are left behind in rural areas because of parental migration. • Children who migrate from rural to urban areas are more likely to be enrolled in preschool and experience more stimulating home learning environments than their peers in rural areas. • Migrant children have lower preschool enrolment rates and receive less stimulation at home than urban native children. This study considers how living arrangements among migrant families have affected young children in China and compares the early learning opportunities of urban migrant children and urban native children. We leveraged nationally representative data from the China Family Panel Studies (2012-2018). Participants were 4,306 three- to five-year-olds and their caregivers. They were classified into five groups, with three of them affected by migration. The sample included 1,357 children who had migrated along with their parents to urban areas; 253 children who were left-behind in rural areas with one parent; and 269 children who were left-behind in rural areas with a relative. An additional 1,595 children from non-migrant families living in rural areas and 832 urban native children served as comparison groups. After adjusting for selection bias through propensity score approaches, results indicated that, regardless of parental migration status, the early learning opportunities of children living in rural areas were similar. Migrating to urban areas was positively associated with stimulating home learning environments and the likelihood of preschool enrollment, but urban native children experienced more stimulating home learning environments and had higher preschool enrollment rates than migrant children. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

There exist significant gaps in nutritional status between urban and rural populations in China. The previous literature has shown that more knowledge and usage of nutrition labels are instrumental in improving diet quality and health. The aim of the study is to analyze: (1) Are there urban–rural disparities in consumer knowledge, use and perceived benefits of nutrition labels in China; (2) If so, what are the magnitudes of the disparities; (3) What can explain the disparities, and how can the disparities be reduced? The Oaxaca–Blinder (O-B) decomposition is utilized to analyze the predictors of urban–rural disparities in nutrition labels based on a self-conducted study of Chinese individuals. The information from a total of 1635 individuals (aged 11–81 years) across China in 2016 was collected in the survey. We find that rural respondents have less knowledge, lower usage and perceived benefits of nutrition labels than their urban counterparts. Demographics, focus on food safety, frequent shopping locations and income jointly explain 98.9% of the disparity in the knowledge of nutrition labels. Nutrition label knowledge is the predictor which contributes most to urban–rural disparity in label use—accounting for 29.6% of the disparity. Nutrition label knowledge and use are the two biggest predictors of disparities in perceived benefits—accounting for 29.7% and 22.8% of the disparity in perceived benefits, respectively. Our study suggests that policies aiming to improve income and education, as well as raising awareness of food safety in rural areas, are promising in closing the urban–rural disparities in nutrition labels knowledge, use, diet quality and health in China. [ABSTRACT FROM AUTHOR]

Abstract Background China has experienced a continuing increase in hypertension prevalence over the past few decades, especially in rural areas. The paper aims to examine the variation of urban–rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults between 2011 and 2015. Methods Our team extracted data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of residents aged 45 years and older. In this study, we used the 2011 wave and the 2015 wave of CHARLS. We calculated crude rates and age-adjusted rates of hypertension prevalence, awareness, treatment, and control for the general, urban, and rural populations in each wave and performed chi-square tests to examine urban–rural disparities. We used logistic regression to further confirm these disparities by controlling confounding factors in each wave. We then used generalized estimating equation (GEE) to further examine whether urban–rural disparities changed between 2011 and 2015. Results We included 11,129 records in the 2011 wave and 8916 records in the 2015 wave in this study. The mean age was 59.0 years and 5359 (48.2%) participants were male in the 2011 wave. Age-adjusted hypertension prevalence, awareness, treatment, control, and control among treated in the total population were 38.5%, 70.6%, 59.2%, 27.4%, and 46.4% in 2015. Urban–rural disparities in the indicators mentioned above were 5.7%, 13.4%, 15.3%, 9.4% and 5.6% in 2011; which decreased to 4.8%, 2.7%, 5.2%, 4.9% and 3.8% in 2015. Urban–rural disparities in prevalence, awareness and treatment were statistically significant in 2011 but not significant in 2015 adjusted for confounding factors, yet control disparities were statistically significant in both waves. Finally, urban–rural disparities in awareness and treatment had narrowed from 2011 to 2015. Conclusions Awareness, treatment, and control rates were sub-optimal among both urban and rural adults. Prevention and management of hypertension among both urban and rural adults should be further strengthened. Awareness and treatment increased more rapidly among rural adults, indicating some achievement had been made in enhancing the healthcare system in rural areas. More efforts are needed in attaining urban–rural equity of healthcare services.

In line with the resource curse literature, this paper examines the effect of oil dependency on the disparities in access to electricity between urban and rural areas in Africa, conditional on the quality of political institutions. Based on data from 36 African countries over the period 2000–2017, our investigation suggests that oil rents (% of GDP) increase urban–rural disparities in access to electricity. However, the quality of institutions shapes the effect of oil dependency on these disparities. Specifically, a 10% increase in the institutional quality score reduces the adverse effects of oil rent on electricity access disparity by around 19%, and the negative impact of oil dependency on urban–rural disparities is reversed when institutional quality reaches a score of 52% on a scale from 0 to 100. The robustness tests support these results and call for strengthening the quality of institutions to overcome the resource curse in Africa. [ABSTRACT FROM AUTHOR]

• Unmet LTC needs, depression, and anxiety were more severe in rural older adults. • Unmet LTC needs were positively related to depression and anxiety in older adults. • Unmet LTC needs had stronger effects on depression and anxiety in urban older adults. • Urban-rural disparities in unmet LTC needs explained some urban-rural disparities in depression and anxiety. This study examined the association of unmet long-term care (LTC) needs with depression and anxiety in older adults and explored urban-rural disparities. Cross-sectional data for 1896 respondents with a mean age of 91.58 years was from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression and anxiety were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Unmet LTC needs were self-reported by older adults with functional limitations. Research methods included regression analyses, decomposition analyses, sensitivity analyses. Results showed that unmet LTC needs, depression, anxiety were more severe in rural older adults. Unmet LTC needs were significantly and positively related to depression and anxiety, but their associations with CESD-10 scores, depressive and anxiety symptoms were stronger in urban older adults. Urban-rural disparities in unmet LTC needs explained about 20%-40% of disparities in depression and anxiety. The findings highlighted the role of meeting LTC needs in reducing depression and anxiety, and that LTC policymakers should not ignore the needs of urban older adults and focus solely on rural older adults. [ABSTRACT FROM AUTHOR]

Understanding the dynamics of clean energy adoption is crucial for shaping effective energy policies and strategies. To understand the spatiotemporal variability and bottom-up spontaneity of the diffusion of clean energy technologies, this study examined the spatiotemporal diffusion of Photovoltaic (PV) systems, Battery Energy Storage Systems (BESS), and Electric Vehicle Charging Stations (EVCS) across 1773 postcode areas in California over the past 35 years. The Bayesian change point detection algorithm (BCDA) was initially utilized to identify temporal change points in the evolution of these technologies, revealing their diffusion trends over time. Then, the Louvain community detection algorithm (LCDA) was employed to elucidate spatial diffusion patterns across regions, offering insights into the geographic proliferation of clean energy solutions. Furthermore, to forecast future distributions, the spatiotemporal graph convolutional network (STGCN) model was applied, adeptly capturing the multi-stage, nonlinear characteristics of clean energy diffusion marked by significant spatiotemporal interactions. With historical data and spatial proximity, the STGCN model demonstrated fine forecasting precision (R^2 ≥ 0.78). This study validates the effectiveness of a graph network-based approach for analyzing the diffusion of clean energy technologies. It recommends policies tailored to account for technological maturity, geographic disparities, and diffusion stages, aiming for equitable and sustainable clean energy development in the region. [Display omitted] [ABSTRACT FROM AUTHOR]

Promoting mental health is an important component of the United Nations' Sustainable Development Goal 3. A large body of literature has found that neighborhood environment is associated with promoting mental health. However, longitudinal evidence on the neighborhood environment—mental health associations remain scarce. This study aimed to (1) examine the longitudinal associations between neighborhood characteristics and adults' mental health in China; and (2) investigate the heterogeneity by age and urbanicity separately. The data came from the China Family Panel Studies (CFPS) in 2010 and 2014. Multilevel modeling was employed to investigate the longitudinal associations and the respective moderating effects by age and urbanicity. The results illustrated that higher number of recreational & sports facilities, fewer number of kindergarten & primary schools, and higher levels of neighborhood aesthetics were associated with better mental health, especially for older adults and rural residents. Our findings suggest that adults' mental health could be improved by making recreational and sports facilities more accessible and by making neighborhoods more visually appealing. It is critical to balance children's educational resources with adults' mental health. The age and urban-rural differences will inform policymakers to develop interventions for more vulnerable populations like older adults and rural residents. • Longitudinal associations between neighborhood characteristics and adults' mental health in China • Examined the moderating effects of age and urbanicity disparities in these associations • More recreational & sports facilities and better aesthetics were associated with better mental health • Fewer kindergarten & primary schools were associted with better mental health • The neighborhood effects on mental health were stronger for older adults or those lived in rural areas [ABSTRACT FROM AUTHOR]

Objective: To investigate emergency medical service (EMS) utilization and its associated factors in patients with acute ischemic stroke (AIS), and further explore the urban-rural differences. Methods: Medical records for AIS in all emergency departments in Beijing were obtained from the Beijing Emergency Care Database from January 2018 to December 2021. EMS utilization was described and factors associated with EMS use were examined by multivariable logistic regression models with the generalized estimating equations. Results were compared between urban and rural districts. Results: A total of 24,296 AIS patients were included in the analysis, and 11,190 (46.1%) were transported to hospitals by EMS. The percentage of EMS usage in urban areas was significantly higher than that in rural areas (53.6 vs. 34.4%, P < 0.001). From 2018 to 2021, EMS utilization was on the increase (P-value for trend <0.001) with a higher average annual growth rate in rural areas (12.6%) than in urban (6.4%). Factors associated with EMS utilization were age (OR: 1.20 per 10-year increase, 95% CI: 1.17-1.23), NIHSS scores, off-hour arrival (OR: 1.32, 95% CI: 1.23-1.37), treatment in tertiary hospitals (OR: 1.75, 95% CI: 1.60-1.92), and possessing comorbidities such as coronary artery disease (OR: 1.15, 95% CI: 1.17-1.24), atrial fibrillation (OR: 1.56, 95% CI: 1.41-1.73), prior stroke (OR: 0.84, 95% CI: 0.78-0.90) or dyslipidemia (OR: 0.78, 95% CI: 0.71-0.85). Conclusion: This study demonstrated an inadequate use of EMS among AIS patients in Beijing, especially in rural areas, and revealed several associated factors. Enhanced education programs and EMS accessibility are necessary particularly for high-risk individuals and regions. [ABSTRACT FROM AUTHOR]

Background: The double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure., Methods: This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010-2011 and 2015, which provided information on women's and children's health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010-2011 and 2015., Results: The average age of mothers was approximately 31 years, and children's ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women., Conclusion: The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban-rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO's Double Duty Actions, are essential to improve the nutritional health of Zimbabwe's population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lukwa, Chiwire, Akinsolu, Okova and Hongoro.)

Due to the rapid innovative applications of technological education as a result of the swift development and popularity of telecommunication and wireless technologies, ever-more diversified methods of technological education play a critical role in various education and lecturing activities, without time and distance restrictions. Currently, in order to bridge the urban–rural development gap, the Taiwanese Government has introduced a lot of policies to encourage teenagers to return their hometowns; however, these policies have not achieved their goals, as the most of Taiwanese community development associations faced scarcities of professional knowledge without any educational support during the development of their various schemes, such as economic development, environmental protection, cultural heritage, public services, etc. As a result, local development depends on entire community development associations, especially in the most mountain regions of Taiwan. Moreover, community development associations have a lot of social responsibilities, such as age-related caring activities, driving local economies and industrial development, environmental protection and education, maintaining and developing traditional cultures and arts, etc. Due to the digital characteristics of technological education, most Taiwanese rural community development associations are able to obtain professional information and data about courses without space and time restrictions. Thus, after strengthening and satisfying professionals’ demands, local economies will achieve growth and, therefore, younger persons would be encouraged to stay their original area, thus stimulating the development of rural community development associations. Eventually, the positive development cycle is predicted to increased and, as a result, the urban–rural disparities will be directly diminished by the diversified application of technological education in Taiwan.

Background: China has experienced a continuing increase in hypertension prevalence over the past few decades, especially in rural areas. The paper aims to examine the variation of urban-rural disparities in hypertension prevalence, awareness, treatment, and control among Chinese middle-aged and older adults between 2011 and 2015.Methods: Our team extracted data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of residents aged 45 years and older. In this study, we used the 2011 wave and the 2015 wave of CHARLS. We calculated crude rates and age-adjusted rates of hypertension prevalence, awareness, treatment, and control for the general, urban, and rural populations in each wave and performed chi-square tests to examine urban-rural disparities. We used logistic regression to further confirm these disparities by controlling confounding factors in each wave. We then used generalized estimating equation (GEE) to further examine whether urban-rural disparities changed between 2011 and 2015.Results: We included 11,129 records in the 2011 wave and 8916 records in the 2015 wave in this study. The mean age was 59.0 years and 5359 (48.2%) participants were male in the 2011 wave. Age-adjusted hypertension prevalence, awareness, treatment, control, and control among treated in the total population were 38.5%, 70.6%, 59.2%, 27.4%, and 46.4% in 2015. Urban-rural disparities in the indicators mentioned above were 5.7%, 13.4%, 15.3%, 9.4% and 5.6% in 2011; which decreased to 4.8%, 2.7%, 5.2%, 4.9% and 3.8% in 2015. Urban-rural disparities in prevalence, awareness and treatment were statistically significant in 2011 but not significant in 2015 adjusted for confounding factors, yet control disparities were statistically significant in both waves. Finally, urban-rural disparities in awareness and treatment had narrowed from 2011 to 2015.Conclusions: Awareness, treatment, and control rates were sub-optimal among both urban and rural adults. Prevention and management of hypertension among both urban and rural adults should be further strengthened. Awareness and treatment increased more rapidly among rural adults, indicating some achievement had been made in enhancing the healthcare system in rural areas. More efforts are needed in attaining urban-rural equity of healthcare services. [ABSTRACT FROM AUTHOR]

There has been an increased concern on indoor air quality (IAQ) in residences since the majority of individuals' time is mainly spent indoors. We inspected and measured indoor environmental parameters in 399 homes in northeast China in order to study IAQ. We systematically measured multilevel environmental parameters (physical, chemical, and biological) in children's bedrooms during all seasons. The results indicated that the median values for indoor temperature, relative humidity, total volatile organic compounds (TVOC), and formaldehyde concentrations throughout the year were within the Chinese national standards. However, the median carbon dioxide concentrations exceeded 1000 ppm during spring, autumn, and winter. In the same seasons, the air change rate (ACR) was below the minimum required level of 0.5 h−1. Di-2-ethylhexyl phthalate (DEHP), di-n-butyl phthalate (DnBP), and di-isobutyl phthalate (DiBP) were predominantly detected in settled dust, displaying median concentrations of 126.9, 41.5, and 16.3 μg/g, respectively. Notably, phthalate concentrations were significantly higher in urban houses as compared to rural houses. Furthermore, median concentrations of Dermatophagoides farinae (Der f) and endotoxin were 689.4 ng/g and 3689.1 EU/g, respectively, trending higher in winter than summer. There was a negative correlation between ACR and chemical pollutants (TVOC, formaldehyde, and DiBP). In conclusion, northeast Chinese homes had poor indoor air quality with ubiquitous exposure to modern chemical compounds and insufficient ventilation. [ABSTRACT FROM AUTHOR]

• The overall rate of flood zone development in US steadily decreased from 2001 to 2019. • US counties with high settlement in flood zones cluster near rivers or coasts. • Counties suffering more from floods tended to have less development in flood zones. • Urban communities exhibit higher exposure and sensitivity to floods than rural ones. Extracting baseline information on flood exposure and its temporal evolution is essential to formulate flood risk reduction strategies. At present, comprehensive, long-term spatial-temporal flood exposure research in the United States is lacking. The objective of the study is to evaluate county-wide flood exposure in the US and unravel its spatial-temporal dynamics from 2001 to 2019 to answer three research questions via hypothesis testing. First, how have human settlement areas exposed to flood threats in the US changed over the past two decades? Second, has the occurrence of floods and their resulting damage influenced the growth of developed areas in flood zones? Third, do disparities exist in the sensitivity to flood threats among urban-rural communities? Results show that the overall rate of development in flood zones in the contiguous United States has steadily decreased from 2001 to 2019. The Local Moran's I analysis discovers pockets of emerging, expanding, shrinking, and changing clusters of communities that show a rapid increase or decrease of developed areas within flood zones over time. Most counties that experienced more frequent flooding events demonstrate greater responsiveness to flood hazards by avoiding development in flood zones. Finally, urban communities exhibit a higher exposure and sensitivity to flood hazards compared to rural areas. [ABSTRACT FROM AUTHOR]

Purpose: To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark. Patients and Methods: We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016– 2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types. Results: We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9– 3.1%], UrC: 3.1% [3.0– 3.1%], RuC: 3.4% [3.3– 3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3– 20.8%], UrC: 17.3% [17.2– 17.4%], RuC: 17.5% [17.5– 17.6%]). Conclusion: Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to examine the urban-rural disparities and associated factors of health care utilization among cancer patients in China.MethodsThis study used the data collected from a cross-sectional survey conducted in China. A total of 1,570 cancer survivors from three urban districts and five rural counties were selected by using a multistage stratified random sampling method. We measured health care utilization with the way of cancer diagnosis, the number of hospitals visited, and receiving alternative therapies. Chi-square test was used to examine the differences between urban and rural cancer patients. Binary logistic regression analysis was performed to explore the determinants of health care utilization.ResultsAmong 1,570 participants, 84.1% were diagnosed with cancer after developing symptoms, 55.6% had visited two and above hospitals, and 5.7% had received alternative therapies. Compared with urban cancer patients, rural ones were more likely to be diagnosed with cancer after developing symptoms (χ2 = 40.04, p < 0.001), while they were less likely to visit more than one hospital (χ2 = 27.14, p < 0.001). Residence area (urban/rural), health insurance type, household income, age at diagnosis, tumor site, stage of tumor, and survival years were significantly associated with health care utilization of cancer patients (p < 0.01).ConclusionsHealth care utilization was suboptimal among cancers patients in China. Rural cancer patients had less health care utilization including screenings and treatments than urban ones. Policymakers should implement specific strategies to ensure equitable utilization of cancer care. More attention should be paid to the disadvantaged groups and rural cancer patients. Prioritizing health resources allocation is needed to prevent, screen, and treat cancers in rural areas.

Abstract Background Neighborhood factors have gained increasing attention, while the association between the neighborhood’s characteristics and multimorbidity has not been clarified. In this study, we aim to depict variations in the number of non-communicable chronic diseases (NCDs) as a function of urban vs. rural settings and road types. Methods The present cross-sectional study derived data from the China Health and Retirement Longitudinal Study 2011 National Baseline Survey. Negative binomial regression with clustered robust standard errors was performed to analyze variations in the number of NCDs among 13,414 Chinese middle-aged and older adults. Logistic regression models were employed to investigate the association between neighborhood-level characteristics and each NCD, respectively. Results First, over 65% of subjects had at least one NCDs, and over 35% had multimorbidity. Arthritis (33.08%), hypertension (24.54%), and digestive disease (21.98%) were the most prevalent NCDs. Urban vs. rural differences in multimorbidity were fully explained by neighborhood clustering variations (IRR = 1.02, 95% CI, 0.95–1.10). Living with paved roads was associated with a smaller number of NCDs relative to living with unpaved roads (IRR = 0.86, 95% CI, 0.78–0.95). Results from subgroup analyses suggested that in comparison with those living with unpaved roads, individuals living with paved roads respectively had lower odds of chronic lung disease (OR = 0.76, 95% CI, 0.63–0.93), chronic liver disease (OR = 0.74, 95% CI, 0.55–0.99), chronic kidney disease (OR = 0.68, 95% CI, 0.51–0.89), digestive disease (OR = 0.82, 95% CI, 0.69–0.97), arthritis or rheumatism (OR = 0.69, 95% CI, 0.55–0.87), and asthma (OR = 0.67, 95% CI, 0.51–0.88). Conclusions Urban vs. rural disparities in multimorbidity appeared to result from within-neighborhoods characteristics. The improvement in neighborhood-level characteristics, such as road pavement, holds promise to alleviate the increasing disease burden of chronic diseases.

Introduction: The digital financial inclusion (DFI) provides opportunities to improve the relative capacity to pay for healthcare services by rural residents who are usually underserved by traditional finance in China. This paper provides empirical evidence on how the development of DFI affects the healthcare expenditure disparities between urban and rural residents., Methods: We employed the fixed effects model and instrumental variable method to estimate the impact of DFI on the Theil index of urban-rural disparities in healthcare expenditures, using panel data from 31 provinces (2011 ~ 2020) in China. We further adopted a moderating effect model to test whether the intensity of the impact would vary depending on the level of local government health expenditures., Results: The results suggest a negative association between the development level of DFI and the urban-rural healthcare expenditure disparities in China. For every 1% increase in the DFI index, the Theil index of urban-rural disparities in healthcare expenditures would fall by 0.0013. After changing the measurement method for the dependent variable and adjusting the sample, the results remain robust. Moreover, the result of the moderating effect model indicates that, a high level of government health expenditures is conducive to the impact of DFI., Discussion: Our research reveals that DFI plays an important role in bridging the urban-rural gap in healthcare expenditures. This finding provides new information for addressing the issue of urban-rural healthcare inequality in China. Chinese government needs to accelerate the construction of digital infrastructure and increase the penetration rate of digital tools in rural areas to promote the beneficial effects of DFI. Additionally, it is also necessary for local government to address the unbalanced allocation of medical resources between urban and rural areas, especially the shortage of rural human resources., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Li, Pang and Coyte.)