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Background: Chronic Obstructive Pulmonary Disease (COPD) poses a substantial burden to Hong Kong. Smoking is the single most important risk factor for COPD. Intensive smoking cessation in COPD patients slows disease progression. Community pharmacy based smoking cessation in healthy smokers could forestall COPD onset. Each of these programs has been proven effective and cost-effective worldwide. Currently there are smoking cessation clinics in Hong Kong. But community pharmacy-based smoking cessation services are not available. The present study firstly attempts to identify the disease burden of COPD; secondly, to investigate if community pharmacy-based smoking cessation services are applicable in Hong Kong; finally, to examine if establishing the services would be cost effective in reducing the burden of COPD. Methods: A series of data analysis of mortality, morbidity and cost of hospitalization (length of stay × standard daily ward cost) was conducted to understand the burden of COPD in Hong Kong. Cost effectiveness analysis based on a Markov model evaluated smoking cessation strategies against usual care: (1) minimal counseling in smoking cessation clinics (MiniC) for COPD patients; (2) intensive counseling with pharmacotherapy in smoking cessation clinics (IC_pharm) for COPD patients; (3) community pharmacist-assisted service (CPA) for healthy smokers; (4) combination of CPA and MiniC (CPA+MiniC); (5) combination of CPA and IC_pharm (CPA+IC_Pharm). The Markov model was constructed by sex, smoking status and COPD severity to calculate the lifetime cost of COPD, cost of smoking cessation programs and QALYs. Both effectiveness and cost were discounted at 3%. Incremental cost effectiveness ratios (ICERs), i.e. cost per one QALY gain, served as the decision making rule. One way sensitivity analysis, threshold analysis and probabilistic sensitivity analysis were performed to explore the uncertainty around the parameters. Results: The overall age adjusted mortality of COPD increased from 28.8 per 100 000 in 1981 to 30.14 per 100 000 in 2008. Numbers of people aged 65+ with known COPD was projected to be over 100 000 by 2036. There were 3.8 and 7.8 years of life lost (YLL) and 3.6 and 5.6 QALYs lost due to COPD for male and female smokers respectively. Medical costs of hospitalization were estimated to be over HK$ one billion (US$132 million) in 2008. Seventy one COPD cases could be avoided in the simulated cohort by CPA. If the threshold value was HK$247 332 for one QALY gain, CPA was more cost effective than IC_Pharm, with an ICER of HK$47 717. CPA+MiniC dominated CPA. CPA+IC_Pharm was more cost effective than CPA+MiniC (ICER, HK$36 000). The probability of CPA+ IC_pharm being the most cost effective strategy was approaching 0.8 if one QALY was worth HK$96 000, and it was associated with the maximum expected QALYs if societal value for one QALY was no less than HK$80 000. Conclusion: The model-based economic evaluation demonstrated that CPA+IC_Pharm would be the most cost-effective smoking cessation strategy. Community pharmacy based (CPA) smoking cessation services could be applicable and should be proposed in Hong Kong to reduce the burden of smoking related diseases. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy

Over the past decade, chronic illnesses have increased significantly in developing regions around the world, with implications for health service provision. Research shows that morbidity follows a social gradient in many countries around the world. Though various studies highlight the importance of socioeconomic status as a predictor of a person’s morbidity and mortality experience, there is a dearth of data and literature in the South African context. This study aimed to address this gap by examining the association between socioeconomic status and diabetes and hypertension among participants aged 35 years and older. This was achieved by undertaking the analysis of secondary data from the National Income Dynamic Study. The findings of the study reveal that there is a significant relationship between socioeconomic factors and chronic health outcomes of individuals. People with lower levels of education were more likely to have a chronic illness than those with higher levels of education. However, interestingly the lowest rates of prevalence were found in the unemployed category in South Africa. This draws attention to the need for further research on employment and chronic disease prevalence. An important finding of the study was the relatively higher prevalence of chronic conditions in rural areas and among the Black/African population. This data suggests that changes in lifestyle and behavior in the context of globalization and urbanization may be contributing to changes in the health profile of these communities. Policy makers need to acknowledge that chronic diseases are no longer the preserve of the wealthy with diseases such as diabetes and hypertension evident across all sectors of South African society. By addressing the causes of chronic conditions policies and programs can aim to prevent the emergence of future epidemics. In the long-term, sustainable progress will only be achieved with greater attention directed towards the socioeconomic factors underlying the health profile of the country. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

[Truncated abstract] The Disability-Adjusted Life Year index, developed by the Global Burden of Disease Study, is used extensively to compare disease burden between locations and over time. While calculation of the fatal component of this measure, Years of Life Lost, is relatively straight-forward, the non-fatal component, Years Lived with Disability, is based on parameters that are challenging to estimate. This thesis pioneers the use of the Western Australian Data Linkage System to enhance epidemiological parameters underpinning Years Lived with Disability, providing, by way of illustration, a robust quantitative profile of burden of stroke in the state of Western Australia at the turn of the 21st century. The principal methodological objective was to utilise data linkage analytic methods for the specific requirements of burden of disease estimation. The principal stroke-related objectives were: 1. To estimate the parameters underpinning the non-fatal burden of stroke (Years Lived with Disability) in Western Australia in 2000. 2. To estimate the total burden of stroke (Disability-Adjusted Life Years) in Western Australia in 2000. 3. To investigate differentials in stroke burden between different sub-populations in Western Australia. 4. To calculate projections of stroke burden for Western Australia in 2016. Years Lived with Disability from stroke were calculated for Western Australia from nonfatal stroke incidence, expected duration and disability (severity) weights. Non-fatal incidence was estimated using linked hospital and death records of first-ever hospitalised stroke 28-day survivors in 2000. This was then adjusted for out-of-hospital cases determined from the population-based Perth Community Stroke Study. iv Analysis of mortality in hospitalised 28-day survivors using linked data revealed that the excess mortality in prevalent, rather than incident cases was the main disease-specific parameter required for modelling stroke duration using DisMod II specialised software. ... Access to data linkage and population-based stroke studies in Western Australia allowed more accurate estimation of non-fatal stroke burden, with previous reports most likely underestimating disability as a contributor to total burden. Although predominantly affecting the growing aged population, stroke also affects a sizable number under the age of 65 years, the age group where differentials in stroke burden are the greatest. The findings highlight the continued need for primary prevention efforts for all ages, targeting especially younger people in disadvantaged groups. The shift to greater disability burden in the future and the needs of disadvantaged groups must be considered when planning stroke services. The multiple studies undertaken for this thesis contribute to ongoing improvement of data quality and methodological refinements underpinning estimates of Years Lived with Disability, specifically for stroke, but applicable also to other diseases. Similar linked data approaches can be used in other Australian states in the future once infrastructure is developed, thereby improving estimates of disease burden for health policy and planning in the future.

This dissertation consists of three essays in the field of health economics. The first essay provides the first causal evidence that bargaining power in a relationship shapes pregnancy outcomes and health disparities in the US. A key driver of bargaining power is the availability of potential non incarcerated male partners in the local dating market, which I define at the race by cohort by county level. Because these sex ratios are endogenous, I use a novel instrument that leverages the randomness in sex at birth and the persistence of local demographics to isolate exogenous variation in the relative availability of men. Greater female bargaining power causes better outcomes: fewer out-of-wedlock births, less chlamydia and hypertension among mothers, and fewer infants with APGAR score below the normal level. The marriage market makes a significant contribution to racial disparities in pregnancy health. Specifically, Black women face relatively poor prospects when looking for a partner compared to White women: while there are 102 White men per 100 White women, only 89 Black men are available per 100 Black women. According to my estimates, Black women’s disadvantage accounts for 5-10% of the large racial gap in maternal and neonatal health. The racial difference in male availability is mostly policy-driven, as incarceration accounts for 45% of the gap. A counterfactual policy equalizing county-level incarceration rates for non-violent offenses between Black and White people would prevent 200-700 adverse pregnancy outcomes per year among Black mothers through the bargaining power channel alone. The second essay investigates how reopening hotels and ski facilities in Poland impacted tourism spending, mobility, and COVID-19 outcomes. We used administrative data from a government program that subsidizes travel to show that the policy increased the consumption of tourism services in ski resorts. By leveraging geolocation data from Facebook, we showed that ski resorts experienced a significant influx of tourists, increasing the number of local users by up to 50%. Furthermore, we confirmed an increase in the probability of meetings between pairs of users from distanced locations and users from tourist and non-tourist areas. As the policy impacted travel and gatherings, we then analyzed its effect on the diffusion of COVID-19. We found that counties with ski facilities experienced more infections after the reopening. Moreover, counties strongly connected to the ski resorts during the reopening had more subsequent cases than weakly connected counties. The third essay studies the diffusion of influenza-like illnesses (ILI) through social and economic networks. Using almost two decades of weekly, county-level infection and mortality data from Poland, it studies within and across-counties ILI transmission. Firstly, it evaluates the causal effect of school closures on viral transmission. The results show that closing schools for two weeks decreases the number of within county cases by 30-40%. The decline in infections extends to elderly and pre-school children. In addition, flu-related hospitalizations drop by 7.5%, and mortality related to respiratory diseases among the elderly drops by 3%. Secondly, the paper demonstrates the significant contribution of economic links to diffusion across counties. The disease follows the paths of workers commuting between home and workplace. Together with the structure of the labor mobility networks, these results highlight the central role of regional capitals in sustaining and spreading the virus.

Lee Suk-Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 69-71). / Abstracts in English and Chinese. / 摘要 --- p.i / Abstract --- p.iii / Acknowledgement --- p.v / Table of Contents --- p.vi / Tables and Figures --- p.vii / Chapter Chapter One --- Introduction --- p.1 / Chapter Chapter Two --- Background and Literature Review --- p.5 / Chapter 2.1 --- Background Review --- p.5 / Chapter 2.2 --- Literature Review - Vaccination of FFLI --- p.12 / Chapter 2.3 --- Literature Review - Social impact and productivity loss of FFLI --- p.23 / Chapter Chapter Three --- Conduct of Survey --- p.29 / Chapter 3.1 --- Study Design --- p.29 / Chapter 3.2 --- Questionnaire --- p.32 / Chapter Chapter Four --- Data Description --- p.36 / Chapter 4.1 --- Participants --- p.36 / Chapter 4.2 --- Incidence and impact of FFLI during the three months period (February - April 2001) --- p.38 / Chapter 4.3 --- Incidence and impact of the most recent FFLI --- p.39 / Chapter Chapter Five --- Economic Loss --- p.45 / Chapter 5.1 --- Estimators - EDPH loss and Productivity loss --- p.45 / Chapter 5.2 --- Density Estimation --- p.50 / Chapter 5.3 --- Hypothesis Testing --- p.51 / Chapter 5.4 --- Sensitivity Analysis --- p.53 / Chapter 5.5 --- Regression Analysis --- p.54 / Chapter 5.6 --- Long Haul flights and Long flights --- p.57 / Chapter 5.7 --- Company Profit --- p.58 / Chapter 5.8 --- Society Loss - GDP --- p.59 / Chapter Chapter Six --- Discussion --- p.61 / Chapter Chapter Seven --- Conclusion --- p.67 / Reference --- p.69 / Tables --- p.72 / Figures --- p.83 / Appendix --- p.87