ᅟThere are many existing methodologies on measuring health equity, while seldom has method aiming at health resource allocation. We collected 6 method of measuring equity in health resource allocation. This paper presents key contents of methods on measuring horizontal equity in health service allocation, yet each method has its advantages and disadvantages as well as range of application, which may help researchers or government to make wise decision when choosing appropriate method for measuring equity. Through comparative analysis, we concluded that socioeconomic factors were considered in concentration index; although the Lorenz curve and Gini-coefficient are widely used, which exist uncertainty and incompleteness; overall inequality can be decomposed by Theil index, which is of significance for the planning of urban and rural areas; preferences on a certain class can be set artificially by Atkinson index; it is easy for Chi-square to analyze aided with statistical software; specific regional differences can be calculated by index of dissimilarity.Classification codesI1Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0010-x) contains supplementary material, which is available to authorized users.
Background The inverse association between physical activity and body fat percentage (%) varies among different populations. We aim to examine whether the significant association between them was uniform across the subpopulations after taking into account body mass index (BMI). Methods Our study relied on data from China Health and Nutrition Surveys in 2015, including 5763 participants aged 40–64 years from 15 regions. Physical activity was calculated as metabolic equivalent task hours per day (MET·h/d). Body fat% was measured by bioelectrical impedance analysis. Body mass index < 24 kg/m2 was defined as normal weight and BMI ≥ 24 kg/m2 was overweight/obese. The effects of physical activity on body fat% were estimated using the Kruskal-Wallis test among sex, age, BMI groups, education, income, region and urbanization. Quantile regression analyses were utilized to describe the relationship between physical activity and body fat% distribution. Results Older adults, overweight/obese, higher education, higher income, residents of central China and those living in areas of higher urbanization had the lower physical activity. Participants who engaged in the highest level of physical activity had 2.0 and 1.5% lower body fat% than the lowest level of physical activity group (23.4, 34.8%) for men and women, respectively. There were 10.4 and 8.8% of normal weight males and females called normal weight obese. Overall, 1 h extra 4.5 MET•h/d was significantly associated with 0.079 and 0.110% less total body fat% at the 75th and 90th percentiles in normal weight males, with 0.071% less at the 25th percentiles in overweight/obese males, with 0.046–0.098% less at the 25th to 90th percentiles in normal weight females, and with 0.035–0.037% less from the 50th to 90th percentiles in overweight/obese females. The inverse association between physical activity and total body fat% was stronger in normal weight obese participants than other subgroups. Conclusions In middle-aged Chinese adults, the inverse association between physical activity and body fat% was only in particular subpopulations rather than the entire population. We should pay much attention to normal weight obese and give a suitable physical activity guideline taking into account people with different body fat%.
What is already known about this topic? The monitoring report on nutrition and health status of Chinese residents from 2010 to 2013 reported that the participation rate of leisure-time physical activity (LTPA) was 13.8% among those 6 years and older. What is added by this report? Among 18 years old and older, the age-standardized LTPA prevalence increased from 7.13% in 2000 to 11.79% in 2011 before dropping to 7.33% in 2015. What are the implications for public health practice? As levels of LTPA participation are low, further research is necessary to develop and test valid interventions to encourage people to take part in more LTPA especially for residents in rural areas and with low-income.
Physical activity is needed in today’s highly sedentary society. Research into Chinese trends with respect to the longitudinal association between changes in physical activity (PA) and dyslipidemia (DL) is limited. The present study assessed PA and PA-related changes associated with the level of serum lipids, and the risk of dyslipidemia stratified by gender, via a population-based longitudinal observational study among adults (>18 years old) residing in nine provinces in China. Data of 3380 adult participants, gleaned from two surveys in 2009 and 2015 used by the China Health and Nutrition Survey (CHNS), were analyzed. Three-level random intercept growth models were used to calculate the associations between total physical activity (TPA), the four activity subtypes, and changes in the level of blood lipids. Three-level logistic regression models were utilized to assess the association between TPA and the risk of DL. The highest level of TPA was observed to correlate with the lowest prevalence of DL. Compared with the lowest level of TPA, the highest level of TPA increases the concentration of HDL-C (β = 0.050, 95% CI = 0.005, 0.096) in males, and also reduces the risk in males of having low HDL-C by 31% (OR = 0.69, 95% CI = 0.52, 0.91). Occupational PA was positively associated with higher HDL-C levels in both genders (males: β = 0.004, 95% CI = 0.002, 0.007; females: β = 0.002, 95% CI = 0.000, 0.004), and leisure-time physical activity (LTPA) was negatively associated with TG levels in males. Increasing TPA benefited HDL-C levels in males, irrespective of the level of basic TPA of individuals. Physical activity (especially occupational PA) was superior in positively influencing HDL-C in males, but not in females. Leisure-time physical activity needs to be increased substantially in order to increase TPA to levels that would be beneficial to blood lipid levels and DL, irrespective of baseline TPA levels.
Physical activity (PA) is of benefit and particularly important for cardiovascular disease risk factors as being sedentary becomes a lifestyle habit. Research into Chinese complex association among physical activity, body-fat percentage (BF%), blood pressure, and serum lipids is limited. The present study is based on an observational study among adults (>18 years old) residing in fifteen provinces in China. Data of 10,148 adult participants in the 2015 China Health and Nutrition Survey (CHNS) were analyzed. The simple mediation effect models with covariates were utilized to assess the association among PA and blood pressure or serum lipids, and BF% was played as a mediator. The serial multiple-mediator models with covariates were constructed to the further analysis of the relationship between PA and blood pressure, and BF% was the mediator 1 and blood lipids were the mediator 2. Based on the above hypothesis, the moderated mediation models with covariates were used to analyze the association among PA, BF%, and blood pressure; in addition, BF% was used as the mediator and blood lipids played as the moderator. In the simple mediation models, the model with a dependent variable was high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C); BF% was played as the partly mediation effect and the proportion of contribution was 0.23 and 0.25, respectively. In the serial multiple-mediator models, blood lipids, as the second mediator, played the mediation effect; however, the effect was smaller than the BF%. In the moderated mediation model, blood lipids had the moderation effect as the moderator variable. HDL-C played a moderating role in the latter pathway of the “PA→BF%→SBP/DBP” mediation model, and LDL-C/TC played a moderating role in the direct effect of the “PA→BF%→DBP”. In conclusion, BF% played a mediating role in the relationship between PA and blood pressure. HDL-C, LDL-C, and TC were more likely to act as moderating variables in the mediation model “PA→BF%→SBP/DBP”. PA could directly and indirectly benefit to control the CVD risk factors simultaneously.
Background As with the unprecedented economic and social development in China, physical activity (PA) have decreased dramatically and body fat percentage (BF%) have varied. In the lasted large scale field investigation, we described the distribution of PA and BF%, and their association across the entire percentiles. Methods Based on data from China Health and Nutrition Surveys (CHNS) in 2015, 5763 participants aged 40-64 years coming from 15 provinces were included. PA was calculated as metabolic equivalent task hours per day (MET·h/d). BF% was measured by bioelectrical impedance analysis (BIA). Kruskal-Wallis test was used to test the difference of PA among gender, age, BMI groups, education, income, region and urbanization. Gender-Body mass index (BMI)-stratified quantile regression (QR) analyses were utilized to describe the association between PA and BF% distribution. Results A part of non-overweight/obese participants had high body fat. Older adults, overweight/obese group, higher education, higher income, residents of central China and higher urbanization had lower PA. Participants who engaged in vigorous PA had median BF% 2.0% and 1.5% lower than the slightly PA group (23.4%, 34.8%) for men and women, respectively. For every additional hour of moderate PA (4.5 MET·h/d), the total BF% was reduced by a median of 0.0290%, 0.0539% and 0.0699% in the 50th, 75th and 90th percentiles respectively, and 0.0490%, 0.0854% and 0.0998% in trunk BF% at the correspondingly percentiles respectively. The association between PA and total BF% was the strongest in normal weight obesity participants than others. Females and the non-overweight/obese group had more statistical significant coefficients at multiple percentiles than males and the overweight/obese group, respectively. Conclusions In middle-aged adults in China, a part of normal weight obesity persons were in non-overweight/obese group and women prone to gain fat mass with BMI increasing but muscle in men. Individuals with vigorous PA had lower BF% comparing with slightly active ones, and an extra moderate leisure PA per day was recommended, especially for normal weight obesity and abdominal adipose individuals.
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