Data_Sheet_1_Factors associated with access to healthcare services for older adults with limited activities of daily living.docx

BackgroundLimited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions).MethodsA total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors.ResultsFactors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, P ConclusionAccess to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.</p

Relationship between two different chronic cardiovascular diseases and degrees of severity.

<p>Note: * Due to the presence of the desired frequency <5, the use of Fisher's exact test.</p

Carotid ultrasound image.

<p>*Representing thickening or plaque of carotid artery. (A) Normal carotid intima; (B) Carotid intimal thickening; (C) Carotid artery plaque.</p

Patient characteristics of study population.

<p>Patient characteristics of study population.</p

The relation between cIMT and CVRFs.

<p><b>A</b> shows the cIMT by the age. Box 1: age 40–50 years; Box 2: age 50–60 years; Box 3: age 60–70 years; Box 4: >70 years. <b>B</b> demonstrates the cIMT by the types of chronic disease. Box 1:hypertension; Box 2: dyslipidemia; Box 3: diabetes. <b>C</b> shows the cIMT by the number of chronic cardiovascular diseases. Box 0:without chronic cardiovascular disease; Box 1:1 type of chroinc cardiovascular disease; Box 2: 2 types of chronic cardiovascular diseases; Box 3:3 types of chronic cardiovascular diseases. <b>D</b> shows the cIMT by two different chronic cardiovascular diseases. Box 1: Combination of hypertension with diabetes; Box 2: combination of dyslipidemia with diabetes; Box 3: combination of hypertension with dyslipidemia.</p

The relationship between different chronic cardiovascular diseases and degrees of severity.

<p>Note: * Due to the presence of the desired frequency <5, the use of Fisher's exact test.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144182#pone.0144182.t004" target="_blank">Table 4</a> shows the relationship between number of chronic cardiovascular diseases and degree of severity. In the group with no chronic disease, cIMT was normal in more than half of the subjects. With the increasing number of chronic cardiovascular disease, the exposure rate of subject’s intimal thickening, plaque formation and moderate carotid stenosis increased. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144182#pone.0144182.g002" target="_blank">Fig 2C</a> shows the cIMT in subjects with different numbers of chronic cardiovascular diseases with significant difference noticed between groups (p<0.05).</p

Relationship between the number of chronic disease and degrees of severity.

<p>Note: * Due to the presence of the desired frequency <5, the use of Fisher's exact test.</p

Carotid ultrasound results based on different age groups.

<p>Note: * Due to the presence of the desired frequency <5, the use of Fisher's exact test.</p

Bafilomycin A1 (Baf) reversed the protective effect of LA against HNE or VK3 in ARPE-19 cells.

<p>Cultures were pre-treated with LA and the indicated concentrations of Baf (30∼300 nM) for 18 h before 18 h exposure to HNE (15 µM) (<b>A</b>) or VK3 (20 µM) (<b>B</b>). MTS assay was used to measure cell viability (<b>A</b>, <b>B</b>) and caspase-3 activity assay to measure apoptosis (<b>C</b>) at the end of the 18 h HNE or VK3 treatment. In MTS assay, *P<0.05 <i>vs</i>. control, ** P<0.05 indicated that the three combinatorial treatment including HNE or VK3, LA, and Baf differed significantly from cultures treated by HNE plus LA or VK3 plus LA; in caspase-3 assay, ** P<0.05 <i>vs</i>. control, ***P, *P <0.05 indicated that the three combinatorial treatment including VK3, LA, and Baf differed significantly from either VK3 or VK3 plus LA treatment respectively. <b>D</b>, ARPE-19 cells were treated by Baf (300 nM), LA (1 µM), Epo (10 nM), LA plus Baf, or Epo plus Baf for 18 h, and then subjected to chymotrypsin-like proteasome activity assay as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0103364#s2" target="_blank">Methods</a>. *P<0.05 indicated significant difference between LA and LA plus Baf or between Epo and Epo plus Baf treatment; **P<0.05 indicated significant difference between control and treatment conditions except by Baf. All the values in control cultures (<b>A</b>, <b>B</b>,<b>C</b>,<b>D</b>) were set at 100% and the values in treated cultures were normalized to the control values. All the results shown are mean (± SEM) of at least triplicate experiments in quadruplicate cultures.</p

Knockdown of Atg7 attenuated the protective effect of LA or Epo.

<p>ARPE-19 cells were transfected with scramble siRNA (SCR), or Atg7-specific siRNA (SiATG7), continued to be cultured for 24 h, followed by pre-treatments with Epo (10 nM, <b>C</b>) or LA (1 µM, <b>D</b>), or sham treatment for 18–24 h, and then subjected to VK3 (20 µM) treatment for 18 h. After the 18 h VK3 treatment, the cultures were subjected to western blot analyses (<b>A</b>) or MTS assay (<b>C</b>, <b>D</b>). The knockdown effects by siRNA were quantified in <b>B</b>, *P<0.05 indicated significant difference between the knockdown effect of SiATG7 and SCR. In <b>C</b>, <b>D</b>, *P<0.05 indicated significant differences between LA or Epo treatment and LA or Epo plus VK3 treatments; ** P<0.05 indicated significant differences between the protective effects of LA or Epo treatment in SCR group and those in SiATG7 group. All the results were averaged from at least triplicate experiments and the values in control were set as 100% and the values in treated conditions were normalized to the control values.</p