Data_Sheet_1_Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City.PDF

IntroductionThis study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China.MethodsData were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses.ResultsThe total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P ConclusionsThe direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.</p

Table_1_Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City.docx

IntroductionThis study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China.MethodsData were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses.ResultsThe total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P ConclusionsThe direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.</p

Presentation1_Underestimated increase and intensification of humid-heat extremes across southeast China due to humidity data inhomogeneity.zip

When co-occurring with elevated levels of ambient relative humidity (RH), hot extremes are more perceivable and consequently more health-damaging. Quantifying changes in humid-heat extremes has therefore gained considerable scientific and societal attention, but a fundamental yet critical aspect to the estimation—data reliability—has been largely downplayed in previous analysis. By comparing ∼10 observational and reanalysis datasets to fully-homogenized observations across China, we report ubiquitous inhomogeneity in RH series in these popularly-used datasets [including HadISD(H) and ERA5], which accordingly produce unrealistically strong drying trends 2–3 times the homogenized dataset-based estimate during 1979–2013 in warm-moist southeast China. Locally, an inhomogeneity-caused exaggeration of drying by a magnitude of 1% decade−1 translates into a significant underestimation of increasing rates for frequency and intensity of humid-heat extremes by more than 1.2 days decade−1 and .07% decade−1 respectively. From a regional perspective, these inhomogeneous records have underestimated the frequency increase of extremes by up to 2 days decade−1 and their intensification by up to .4°C decade−1 in southeast China. Extremes identified via homogenized and non-homogenized datasets also differ in the bivariate joint distribution structure, with former cases featuring similarly hot temperatures yet discernably lower humidity.</p

Background information of avian influenza H9N2 viruses examined in this study.

a<p>Expressed as the log₁₀ EID₅₀ required to give 1 MID₅₀ or 1 MLD₅₀.</p>b<p>Lethality was determined by the mortality in 4-wk-old SPF chickens with intranasal infection with each of six H9N2 viruses at a dose 10⁷ EID₅₀. “Non” means no death of chickens over 21-day observation period.</p

Phylogenetic trees for HA (<i>A</i>), NA (<i>B</i>), M (<i>C</i>) and NS (<i>D</i>) genes of the H9N2 influenza viruses analyzed.

<p>Trees were generated by the neighbor-joining method with the MEGA program (version 4.1). Nucleotides 80–1090 (1011 bp, HA), 20–1420 (1401 bp, NA), 26–984 (959 bp, M) and 41–859 (819 bp, NS) were used for phylogenetic analysis. The HA phylogenetic tree is rooted to A/Duck/Alberta/60/76(H12N5), and the trees of NA, M, and NS are rooted to A/Equine/Praque/1/56(H7N7). The length of the horizontal lines is proportional to the minimum number of nucleotide differences required to join nodes. Vertical lines are for spacing and labeling. Viruses characterized in this study are highlighted in bold, representative H9N2 viruses are in red, viruses isolated from swine and human are in green, and H5N1 influenza viruses are highlighted with asterisk. Abbreviations: Ck, chicken; Dk, duck; Sw, swine; Gf, guinea fowl; Pg, pigeon; Gs, goose; Qa, quail; Ty, turkey; Pf, peregrine falcon; WDk, wild duck; Cu, chukar; HK, Hong Kong; WI, Wisconsin, Bei, Beijing; CA, California; VNM; Viet Nam.</p

Body weight and temperature of mice after H9N2 viral infection.

<p>Mice were inoculated i.n. with 10⁶ EID₅₀ of Ck/HB/4/08 H9N2 viruses. Body weight (<i>A</i>) and temperature (<i>B</i>) were monitored daily for a 14-day observation period. Body weight was expressed as a percentage of the initial value. Data represent the mean of at least three mice of each group.</p

Phylogenetic trees for PB2 (<i>A</i>), PB1 (<i>B</i>), PA (<i>C</i>) and NP (<i>D</i>) genes of the H9N2 influenza viruses analyzed.

<p>Trees were generated on the basis of the following gene sequences: nucleotides 28–2307 (2279 bp, PB2), 40–1473 (1434 bp, PB1), 25–2175 (2151 bp, PA) and 46–1542 (1497 bp, NP). The PB2 and NP trees are rooted to A/Equine/Praque/1/56(H7N7), and the PB1 and PA trees to A/Equine/London/1416/73(H7N7). The other information was described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013063#pone-0013063-g001" target="_blank">Fig. 1</a>.</p

Replication of H9N2 viruses in tissues of mice.

a<p>Mice (n = 3) were inoculated i.n., and tissues were taken on days 5 p.i. Clarified homogenates of tissues were titrated for virus infectivity in eggs from initial dilutions of 1∶10. Mean viral titers are expressed as log₁₀ EID₅₀ per 10 milligram wet tissues.</p>b<p>Average virus titers for each tissue (the number of positives/total number tested for each virus).</p>c<p><, no virus detectable at dilution of ≥10⁻¹.</p

Comparison of amino acid sequences of HA and NA of H9N2 viruses tested in this study

a<p>RBS, receptor binding site.</p>b<p>Amino acid sequence of residues 324–330 (numbering according to H3 HA) at the cleavage site between HA1 and HA2; aa, amino acid.</p

Replication of H9N2 viruses in lungs of mice and chickens.

a<p>Mice and chickens (n = 3) were infected i.n. with each of six H9N2 viruses at a dose of 10⁶ EID₅₀ (mice), or 10⁷ EID₅₀ (chickens). Clarified homogenates of lungs were titrated for virus infectivity in eggs from initial dilutions of 1∶10. Virus endpoint titers were expressed as mean log₁₀ EID₅₀ per 10 milligram wet tissues ± standard deviation (SD).</p>b<p><, no virus detectable at dilution of ≥10⁻¹.</p