China has a population of 1.39 billion. Average life expectancy is 75 years.(1)
The health system in modern China traces it roots back to 1949, when the Communist Party created a health system built on government owned facilities and practically free provision of service. As part of a general push towards privatisation and free markets in the early 1980’s, funding for the health care and public health systems dropped dramatically. Economic and geographic health disparities increased, and public trust in the health systems and physicians dropped. (2) To counter the trend and increase health coverage and output, the early 2000’s saw new reforms being introduced, shifting focus to publically funded care. A primary care system was rolled out nationwide and in 2008 a modest but comprehensive health insurance was introduced, covering approximately 95% of the population by 2012. (3)
COPD burden and management
COPD prevalence is 3,953 per 100,000. COPD is a major and increasing cause of morbidity in China. Smoking rates are high among men, and in the whole population exposure to air pollution is a common risk factor. Indoor pollution from solid fuel, outdoor particulates, occupational exposure and second hand smoke all add notably to the burden of disease. All in all COPD causes about 4% of total morbidity (DALYs), highest among the included countries. (4)
While there is a growing academic awareness about the burden of COPD, there is still a lack of knowledge among the population and physicians. (4,5) This contributes to late diagnosis and makes misdiagnosis and mistreatment common. Usage of primary care is low with patients generally preferring to go directly to hospitals. (6) Responsibility for long term follow up lies with primary care providers. When diagnosed, investigation seldom involves spirometry and patients are over-prescribed short-acting beta agonists (SABAs), while treatment with corticosteroids and long-acting inhalers are rare. (5)
- World Health Organisation (2015) China: WHO statistical profile. World Health Organization. Available at: http://www.who.int/gho/countries/chn.pdf
- Yip, W., & Hsiao, W. C. (2015) What drove the cycles of Chinese health system reforms?. Health Systems & Reform, 1(1), 52-61.
- Cheng, T. M. (2012) Early results of China’s historic health reforms: the view from Minister Chen Zhu. Health Affairs, 31(11), 2536-2544.
- Lou, P., Zhu, Y., Chen, P., Zhang, P., Yu, J., Zhang, N., Chen, N., Zhang, L., Wu, H. and Zhao, J., (2012) Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study. BMC Public Health, 12(1), p.287.
- Fang et al (2011) COPD in China. CHEST , Volume 139 , Issue 4 , 920 - 929
- Blumenthal, D., & Hsiao, W. (2005) Privatization and its discontents: The evolving chinese health care system. The New England journal of medicine, 353(11), 1165-1170.
Principal Investigators: Chunhua Chi and K K Cheng
Lead researcher:Zihan Pan
Project Manager: Xia Kong
Breathe Well study
Summary research question
What are the most cost effective screening strategies for identifying undiagnosed COPD in the general population in China?
Cross sectional (screening test accuracy)
Ethical approval for the study was granted in August 2018 and it has been registered on ISRTCN. The contract with the University of Birmingham has been signed. Equipment has been distributed to the 8 study sites and the staff received training in spirometry. The study protocol will be published shortly. The launch meeting took place in January 2019. All the GPs involved in Breathe Well in China have reviewed how to use all the materials and the skills required. The study pilot was underaken in February and March 2019 in Caiyu community health center (CHC), Beijing and Shayuan community health center (CHC), Guangzhou. The lessons from the pilot are now being analysed and shared with the team. More study sites will start recruitment of patients very soon.
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This research was commissioned by the National Institute for Health Research (NIHR) NIHR Global Health Research Group on Global COPD in Primary Care using UK aid from the UK Government. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.