Impaired hearing and cognition are disabling conditions among older adults. Research has presented inconsistent conclusions regarding hearing impairment posing a risk for cognitive impairment. We aimed to assess this from published evidence via searching PubMed and Embase, from the inception of the databases indexed to December 2, 2016. For those high-quality studies retrieved, relative risk (RR) and 95% confidence intervals (CIs) were combined to estimate the risk of cognitive impairment. Eleven cohort studies were included in the present study. Pooled results found that elderly people with disabled peripheral and central hearing function had a higher risk of cognitive impairment (for moderate/severe peripheral hearing impairment: RR = 1.29, 95% CI: 1.04–1.59 during a follow-up ≤6 years. RR = 1.57, 95% CI: 1.13–2.20 during a follow-up >6 years; for severe central hearing impairment, RR = 3.21, 95% CI: 1.19–8.69) compared to those with normal hearing function. We also recorded a dose-response trend for cognitive impairment as hearing thresholds rose. No evident bias from potential confounding factors was found with one exception: the length for clinical follow-up. Although results are preliminary because qualifying studies were few, statistical findings were consistent with older people identified as having greater levels of hearing loss, having a corresponding higher risk of cognitive impairment.
Background and Purpose— Stroke has been the leading cause of death in China. The aim of this study is to assess the long-term trends of stroke mortality in China between 1994 and 2013. Methods— The mortality data were obtained from the GBD 2013 (Global Burden of Disease Study 2013) and were analyzed with the age–period–cohort framework. Results— We found that the net drift was −2.665% (95% confidence interval, −2.854% to −2.474%) per year for men and −4.064% (95% confidence interval, −4.279% to −3.849%) per year for women, and the local drift values were below 0 in all age groups ( P <0.05 for all) in both sexes during the period of 1994 to 2013. In the same birth cohort, the risk of death from stroke rose exponentially with age for both sexes after controlling for period deviations. The estimated period and cohort relative risks were found in similar monotonic downward patterns (significantly with P <0.05 for all) for both sexes, with more quickly decreasing for women than for men during the whole period (significantly with P <0.05 for both). Conclusions— The decreased mortality rates of stroke in China are likely to be related to improvements in medical care and techniques, spectacular economic growth and fast urbanization, and better early life nutrition conditions of Chinese people. Besides, better education and better awareness of stroke-related knowledge in successive generations could also probably play a role.
This study established a set of indicators for and evaluated the effects of health care system reform in Hubei Province (China) from 2009 to 2011 with the purpose of providing guidance to policy-makers regarding health care system reform. The resulting indicators are based on the “Result Chain” logic model and include the following four domains: Inputs and Processes, Outputs, Outcomes and Impact. Health care system reform was evaluated using the weighted TOPSIS and weighted Rank Sum Ratio methods. Ultimately, the study established a set of indicators including four grade-1 indicators, 16 grade-2 indicators and 76 grade-3 indicators. The effects of the reforms increased year by year from 2009 to 2011 in Hubei Province. The health status of urban and rural populations and the accessibility, equity and quality of health services in Hubei Province were improved after the reforms. This sub-national case can be considered an example of a useful approach to the evaluation of the effects of health care system reform, one that could potentially be applied in other provinces or nationally.
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