Abstract
Chronic noncommunicable diseases, which can be referred to as chronic diseases, have become a significant challenge to global public health. Various studies have shown that traditional Chinese medicine (TCM) therapies are effective means of preventing and treating chronic diseases. The purpose of our study was to analyze the present circumstances of the use of TCM therapies among Chinese patients who have chronic diseases and explore the related influencing factors. Using datasets from the 2021 China General Social Survey (CGSS), we collected basic information, health status, and lifestyle data from 1,023 residents who suffered from at least one chronic disease. We analyzed the distribution characteristics of different indicators among patients using TCM therapies through the χ2 test and determined the main factors influencing the use of TCM therapies through binary logistic regression analysis. Among the 1,023 patients with chronic diseases, 502 (49.07%) used TCM therapies. The five types of TCM therapies were used in the following order of frequency: Chinese herbal medicine (73.11%), cupping (37.45%), acupressure or massage (31.27%), acupuncture (30.48%), and moxibustion (23.11%). Age, self-rated health status, frequency of drinking, frequency of medical visits in the past year, media information sources, types of chronic diseases, and comorbidities significantly affected the use of TCM therapies (P < 0.05). Compared with the population aged over 81 years, patients aged 41–60 years (OR: 1.978, 95% CI: 1.069–3.663) had a higher rate of TCM therapy use. Compared with patients who never drank, those who drank several times a year or less (OR: 1.628, 95% CI: 1.031–2.569) had a higher rate of TCM therapy use. Compared with patients who had never visited a doctor in the past year, those who had visited a doctor several times a week (OR: 2.888, 95% CI: 1.047–7.966), approximately once a week (OR: 3.101, 95% CI: 1.369–7.023), approximately once a month (OR: 1.988, 95% CI: 1.239–3.190), or several times a year (OR: 1.734, 95% CI: 1.202–2.502) had a greater rate of TCM therapy use. Compared with patients whose self-rated health status was poor, those whose self-rated health status was normal (OR: 0.709, 95% CI: 0.504–0.996) had a lower rate of TCM therapy use. Compared with patients who obtained media information through more than three sources, those who obtained it only through television (OR: 0.624, 95% CI: 0.410–0.948) had a lower rate of TCM therapy use. Compared with patients who suffered from three or more chronic diseases simultaneously, those who suffered from hypertension (OR: 0.260, 95% CI: 0.134 ~ 0.507) alone, diabetes (OR: 0.359, 95% CI: 0.149 ~ 0.864) alone, musculoskeletal diseases (OR: 0.466, 95% CI: 0.237 ~ 0.917) alone, other types of chronic diseases (OR: 0.367, 95% CI: 0.191 ~ 0.706) alone, and two (OR: 0.394, 95% CI: 0.212 ~ 0.732) or three (OR: 0.375, 95% CI: 0.186 ~ 0.755) kinds of chronic diseases simultaneously had a lower rate of TCM therapy use. Many factors affect the use of TCM therapies in patients with chronic diseases. The government and relevant departments should understand the trend in the use of TCM therapies in chronic disease management, accurately identify the characteristics of the population that has chronic diseases, optimize publicity channels, enhance the accessibility and acceptance of TCM therapies in global chronic disease health management, and provide practical references for enriching the methods available for preventing and treating chronic diseases.
Keywords: TCM therapies, Prevention and treatment of chronic diseases, Influencing factors, Comorbidities
Subject terms: Diseases, Health care
Background
As the global burden of disease continues to increase, chronic noncommunicable diseases have gradually become major public health problems that affect the economic and social progress of countries1–3. The World Health Organization declared that seven of the top 10 causes of death worldwide in 2021 were noncommunicable (chronic) diseases, accounting for 38% of global deaths4. Identifying additional strategies to prevent and control chronic diseases is important for decreasing the prevalence and mortality of chronic diseases worldwide and promoting individual health2. The 2019 Global Traditional and Complementary Medicine Report clearly indicates that traditional and complementary medicine (T&CM) has a significant impact on the prevention and treatment of chronic diseases, which has prompted a re-evaluation of the valuable role of T&CM in the global health field. Globally, T&CM is widely used in the prevention and treatment of chronic diseases. For instance, in India, the traditional natural therapy Ayurveda is regarded as a means to assist in managing chronic diseases5. The popular homeopathic therapy has also been demonstrated to have a positive effect in treating chronic comorbidities in a study6. Moreover, traditional Chinese medicine (TCM), an important component of T&CM7, has a unique advantage in the area of preventing and treating chronic diseases because of its long history and cultural heritage. These facts indicate that T&CM is an important part of global prevention strategies for chronic diseases. Its unique concepts and methods can enrich the toolkit for chronic disease prevention and control.
TCM therapies include both drug therapies and nondrug therapies, among which drug therapies mainly include single and compound Chinese herbal medicine (Chinese medicine prescriptions). Nondrug therapies mainly include acupuncture, moxibustion, massage, cupping, scraping and acupoint burying. Numerous studies have shown that TCM therapies have significant effects on the prevention and treatment of chronic diseases. For example, Minchom A et al.8 reported that acupuncture and moxibustion can effectively relieve symptoms such as dyspnea in cancer patients with terminal illness. Xiong W et al.9 reported that acupuncture effectively assisted in the treatment of patients with chronic kidney disease and controlled the complications of hemodialysis. Zhang K et al.10 reported that moxibustion, acupoint burying, TCM hot compress therapy and other TCM topical therapies can be combined with Western medicine therapy, which can be more effective in the treatment of chronic prostatitis/chronic pelvic syndrome. Zhu HZ et al.11 proved through a controlled trial that Chinese medicine prescriptions could ease the clinical manifestations of chronic obstructive pulmonary disease (COPD). In addition, Chinese herbs such as puerarin have been used to prevent and treat cardiovascular and cerebrovascular diseases12. These research results concerning the application of TCM therapies for the prevention and treatment of chronic diseases not only further confirmed the reliability of TCM therapies but also promoted the international recognition of and attention paid to TCM13.
In recent years, the Chinese government has given significant attention to the role of TCM in the prevention and treatment of chronic diseases and has introduced a series of relevant policies. Among them, Medium-and long-term planning for the prevention and treatment of chronic diseases in China(2017–2025) advocates integrating the concept of “TCM treats diseases before they occur” into the prevention of chronic disease. The complementary advantages of TCM and Western medicine should be emphasized in the treatment of chronic diseases. In addition, TCM rehabilitation technology should be promoted at the grassroots level and included in the rehabilitation process for chronic diseases14. These methods provide useful references and lessons for the prevention and treatment of chronic diseases with TCM worldwide, and they coincide with the view of the World Health Organization that traditional and complementary medicine (T&CM) in the prevention and treatment of chronic diseases should focus on primary health care7.
However, despite the increasingly extensive application of TCM in the field of chronic disease prevention and treatment, current studies have focused mostly on the validation of the clinical efficacy of TCM therapies, and studies focusing on the specific factors affecting the use of TCM therapies by patients with chronic diseases are relatively scarce. On the basis of the above findings, the objective of this study was to analyze the current situation of Chinese patients with chronic diseases treated with TCM therapies, identify the factors affecting their use of TCM therapies by statistical methods, and propose corresponding countermeasures and suggestions to provide scientific evidence for promoting the internationalization of TCM and improving the prevention and treatment of chronic diseases worldwide.
Methods
Data collection
This study was conducted using the Chinese General Social Survey (CGSS) database. CGSS, which started in 2003, was implemented by Renmin University of China and approved by the Ethics Review Committee of Renmin University of China. It is a continuous cross-sectional survey targeting the population aged 18 and above and uses a multistage stratified sampling method. This project is China’s earliest national, comprehensive and continuous academic investigation, and it is the main data source for summarizing how social trends change and discussing topics with great scientific and real-world implications15. Survey data from CGSS2021 was applied in this study. It mainly involves respondents from 320 villages and communities in 19 provinces (autonomous regions and municipalities directly under the Central Government) of China (excluding Hong Kong, Macao, and Taiwan), with a total sample size of 8,148 people.
Inclusion and exclusion criteria
Using the question “Are you suffering from chronic diseases or having long-term health problems” in the CGSS as the main screening criterion, missing values and blank data were eliminated, and 1,023 patients with various chronic diseases were ultimately included in the research. The screening process is shown in Fig. 1. The main chronic diseases include hypertension, diabetes, cardiovascular and cerebrovascular diseases, musculoskeletal diseases (e.g., arthritis, low back pain, knee problems, joint pain, rheumatism), respiratory diseases (e.g., asthma, emphysema), and others (dyslipidemia, stroke, cancer, mental disorders, kidney disease, liver disease, digestive diseases).
Fig. 1.
Data screening flow chart.
Taking the traditional Chinese medicine module of the CGSS as an example, the question “Have you received any of the following treatments during the past year?” was utilized as the criterion to determine if an individual had undergone TCM therapy. This variable was designated the dependent variable in the analysis.
The independent variable was divided into three dimensions:
Basic characteristics of the patients: sex, age, nationality, education level, place of residence, average monthly family income, self-rated health status, employment status, and medical insurance status.
-
(2)
Patient behavior and lifestyle: smoking status, frequency of drinking, sleep quality, and media information sources.
-
(3)
Patient condition: the extent to which pain affects normal work, the frequency of medical visits in the past year, and the types of chronic diseases and comorbidities.
Some of the independent variables are defined as:
Self-assessment of health status: Taking the theme module of the CGSS, the question “In your opinion, what is your current state of physical health?” was utilized as the criterion.
-
(2)
Average monthly family income: Taking the CGSS core module and the question “What is your family’s total household income in 2020” as the measurement standard, the answers to “Total household income in 2020 is higher than one million digits”, “Not applicable”, “Don’t know” and “Refuse to answer” are classified as missing values. The multiple imputation method was applied to address these missing values with the computational formula:
Average monthly family income = family’s total household income/12.
-
(3)
Employment status: Taking the core module of the CGSS, the question “What kind of work experience do you have, and what is your current employment situation?” was utilized as the criterion. “Currently engaged in off-farm work” was defined as “off-farm work”; “Currently engaged in agriculture, have had nonagricultural work” and “currently engaged in agriculture, have not had nonagricultural work” were defined as “farming”; “Currently not employed and have only worked in agriculture”, “currently not employed and have had off-farm employment”, and “never worked” were defined as “not employed”.
-
(4)
Medical insurance status: Taking the core module of the CGSS, the question “Which of the following forms of medical insurance do you have?” was utilized as the criterion. “Only commercial insurance” and “no medical insurance” were defined as “no public medical insurance”.
-
(5)
Sleep quality: Taking the theme module of the CGSS, the question “How do you rate your sleep quality in the past month?” was utilized as the criterion.
The detailed assignments of the independent variables are shown in Table 1.
Table 1.
Assignment of independent variables.
| Category | Variable name | Variable assignment |
|---|---|---|
| Individual basic characteristics of patients | sex | 1 = male; 2 = female |
| age | 1 = 40 years old and younger; 2 = 41–60 years old; 3 = 61–80 years old; 4 = 81 years and older | |
| nationality | 1 = Han nationality; 2 = other nationalities | |
| education level | 1 = primary school or below; 2 = junior high school; 3 = high school/technical secondary school; 4 = college; 5 = bachelor degree or above | |
| place of residence | 1 = city; 2 = rural | |
| average monthly family income | 1 = 3000 yuan or less; 2 = 3001–6000 yuan; 3 = 6001 yuan or above; | |
| employment status | 1 = nonfarm work; 2 = farming; 3 = no job | |
| self-assessed health status | 1 = excellent; 2 = very good; 3 = good; 4 = general; 5 = bad | |
| medical insurance status | 1 = only public health insurance; 2 = public health insurance and commercial insurance; 3 = no public health insurance; 4 = uncertain | |
| Patients’ behavior and lifestyle | smoking status | 1 = smoke now; 2 = used to smoke, but do not smoke now; 3 = hardly/never smoke |
| frequency of drinking | 1 = drink every day; 2 = several times during a week; 3 = several times during a month; 4 = a few times a year or even less; 5 = no alcohol | |
| sleep quality | 1 = excellent; 2 = relatively good; 3 = relatively poor; 4 = very bad | |
| media information sources | 1 = only through TV to obtain media information; 2 = only through internet to obtain media information; 3 = only through other means to obtain media information; 4 = through two ways to obtain media information; 5 = through three ways to obtain media information; 6 = through more than three ways to obtain media information | |
| Condition of the patients | extent to which pain affects normal work | 1 = no effect; 2 = slight effect; 3 = moderate effect; 4 = a relatively large effect; 5 = a very large effect |
| frequency of medical visits in the past year | 1 = several times during a week; 2 = about once a week; 3 = about once a month; 4 = several times during a year; 5 = about once a year; 6 = never | |
| types of chronic diseases and comorbidities | 1 = suffer from hypertension alone; 2 = suffer from diabetic alone; 3 = suffer from cardiovascular and cerebrovascular diseases alone; 4 = suffer from musculoskeletal disease alone; 5 = suffer from respiratory disease alone; 6 = suffer from other chronic diseases alone; 7 = suffer from two kinds of chronic diseases simultaneously; 8 = suffer from three kinds of chronic diseases simultaneously; 9 = suffer from more than three chronic diseases simultaneously |
Statistical analysis
In this study, SPSS 27.0 was used for statistical analysis, and descriptive analysis was used to analyze the count datasets, which were expressed as n (%). We used the Pearson χ2 test to analyze the situation of patients with chronic diseases of different characteristics treated with TCM therapies and to explore whether there were significant differences among different categorical variables. Since there are only two ways for people with chronic diseases to choose whether to use TCM therapies, namely, yes or no, this is a binary dependent variable. Therefore, binary logistic regression was used to analyze the factors influencing the use of TCM among patients with chronic diseases. P < 0.05 was considered statistically significant.
Results
Basic information of the research subjects
A total of 1,023 patients with chronic diseases were selected, including 451 men (44.09%) and 572 women (55.91%). The ages of the patients were concentrated in the range of 61–80 years, with a total of 534 people, accounting for 52.20% of the sample. The majority of the patients were of Han nationality, a total of 957 people (93.55%). In terms of educational attainment, those with primary school education or below (491,48.00%) and those with junior high school education (299,29.23%) constituted the majority. A total of 505 patients (49.36%) lived in urban areas, and 518 people (50.64%) lived in rural areas. The average monthly family income of most patients was concentrated at 6,001 yuan or above, with a total of 425 patients (50.35%). In terms of employment status, patients who had no job constituted the majority (649, 63.44%). Most patients rated their self-assessed health status as general (531,51.91%). With respect to medical insurance, those with only public medical insurance constituted the majority (877, 85.73%). Most people hardly or never smoked (653, 63.83%). Most patients did not drink (725,70.87%). Most patients had relatively good sleep quality (479, 46.82%). In terms of media usage, some patients obtained information only through television (208, 20.33%) but most patients obtained information through a combination of more than three methods (348, 34.02%). Most patients thought that physical pain had a slight impact on their normal work (297, 29.03%). Most patients sought medical treatment several times a year (431, 42.13%). Among those with chronic diseases, those who suffered from hypertension alone constituted the majority (173, 16.91%). Among the patients with comorbid chronic diseases, those who suffered from two types of chronic diseases simultaneously constituted the majority (243, 23.75%).
Types of TCM therapies used by patients with chronic diseases
Among the 1,023 patients with chronic diseases, 502 patients (49.07%) used TCM therapies, and 521 patients (50.93%) did not use TCM therapies. Among them, the largest number of patients (367, 73.11%) used Chinese herbal medicine; the smallest number of patients (116, 23.11%) used moxibustion treatment. The types of TCM therapies used by the population with chronic diseases are shown in Table 2.
Table 2.
Types of TCM therapies used by patients with chronic diseases (n = 1,023).
| Types of TCM therapies | The number of users | Usage rate (%) |
|---|---|---|
| Chinese herbal medicine | 367 | 73.11 |
| cupping | 188 | 37.45 |
| acupressure or massage | 157 | 31.27 |
| acupuncture | 153 | 30.48 |
| moxibustion | 116 | 23.11 |
Chi-square test for chronic disease patients with different characteristics who used TCM therapies
To evaluate the differences between groups, we used χ2 tests to compare the use of traditional Chinese medicine by patients with chronic diseases of different characteristics. The differences in self-rated health status (χ2=14.210, P = 0.007), the degree to which pain affects normal work (χ2=10.453, P = 0.033), smoking status (χ2=10.218, P = 0.006), frequency of drinking (χ2=16.690, P = 0.002), sleep quality (χ2=9.633, P = 0.022), frequency of medical visits in the past year (χ2=38.643, P<0.01), medical insurance status (χ2=9.417, P = 0.024), media information sources (χ2=12.952, P = 0.024), and different types of chronic diseases and comorbidity conditions (χ2=34.992, P<0.01) were statistically significant (P < 0.05), as shown in Table 3.
Table 3.
Situations of patients with different chronic diseases who used TCM therapies.
| Variable | Category | The number of patients with chronic diseases | The number of people using TCM therapies | Usage rate % |
χ2 value | P value |
|---|---|---|---|---|---|---|
| sex | male | 451 | 215 | 47.67 | 0.632 | 0.427 |
| female | 572 | 287 | 50.17 | |||
| age | 40 years old and younger | 83 | 43 | 51.81 | 5.981 | 0.113 |
| 41–60 years old | 341 | 181 | 53.08 | |||
| 61–80 years old | 534 | 253 | 47.38 | |||
| 81 years and older | 65 | 25 | 38.46 | |||
| nationality | Han nationality | 957 | 468 | 48.90 | 0.169 | 0.681 |
| other nationalities | 66 | 34 | 51.52 | |||
| education level | primary school or below | 491 | 228 | 46.44 | 5.623 | 0.229 |
| junior high school | 299 | 158 | 52.84 | |||
| high school/technical secondary school | 150 | 69 | 46.00 | |||
| college | 33 | 18 | 54.55 | |||
| bachelor degree or above | 50 | 29 | 58.00 | |||
| place of residence | city | 505 | 247 | 48.91 | 0.010 | 0.919 |
| rural | 518 | 255 | 49.23 | |||
| average monthly family income | 3000 yuan or less | 409 | 202 | 49.39 | 1.259 | 0.533 |
| 3001–6000 yuan | 189 | 86 | 45.50 | |||
| 6001 yuan or above | 425 | 214 | 50.35 | |||
| employment status | nonfarm work | 174 | 85 | 48.85 | 1.203 | 0.548 |
| farming | 200 | 105 | 52.50 | |||
| no job | 649 | 312 | 48.07 | |||
| self-assessed health status | excellent | 17 | 6 | 35.29 | 14.210 | 0.007 |
| very good | 92 | 38 | 41.30 | |||
| good | 106 | 48 | 45.28 | |||
| general | 531 | 249 | 46.89 | |||
| bad | 277 | 161 | 58.12 | |||
| medical insurance status | only public health insurance | 877 | 418 | 47.66 | 9.417 | 0.024 |
| public health insurance and commercial insurance | 86 | 54 | 62.79 | |||
| no public health insurance | 45 | 20 | 44.44 | |||
| uncertain | 15 | 10 | 66.67 | |||
| smoking status | smoke now | 228 | 93 | 40.79 | 10.218 | 0.006 |
| used to smoke, but do not smoke now | 142 | 81 | 57.04 | |||
| hardly/never smoke | 653 | 328 | 50.23 | |||
| frequency of drinking | drink every day | 75 | 24 | 32.00 | 16.690 | 0.002 |
| several times during a week | 46 | 17 | 36.96 | |||
| several times during a month | 64 | 34 | 53.13 | |||
| a few times a year or even less | 113 | 67 | 59.29 | |||
| no alcohol | 725 | 360 | 49.66 | |||
| sleep quality | excellent | 157 | 76 | 48.41 | 9.633 | 0.022 |
| relatively good | 479 | 213 | 44.48 | |||
| relatively poor | 292 | 160 | 54.79 | |||
| very bad | 95 | 53 | 55.79 | |||
| media information sources | only through TV to obtain media information | 208 | 83 | 39.90 | 12.952 | 0.024 |
| only through internet to obtain media information | 27 | 16 | 59.26 | |||
| only through other means to obtain media information | 30 | 16 | 53.33 | |||
| through two ways to obtain media information | 232 | 118 | 50.86 | |||
| through three ways to obtain media information | 178 | 81 | 45.51 | |||
| through more than three ways to obtain media information | 348 | 188 | 54.02 | |||
| extent to which pain affects normal work | no effect | 220 | 113 | 51.36 | 10.453 | 0.033 |
| slight effect | 297 | 154 | 51.85 | |||
| moderate effect | 153 | 83 | 54.25 | |||
| a relatively large effect | 243 | 98 | 40.33 | |||
| a very large effect | 110 | 54 | 49.09 | |||
| frequency of medical visits in the past year | several times during a week | 21 | 14 | 66.67 | 38.643 | <0.01 |
| about once a week | 38 | 27 | 71.05 | |||
| about once a month | 145 | 83 | 57.24 | |||
| several times during a year | 431 | 231 | 53.60 | |||
| about once a year | 175 | 73 | 41.71 | |||
| never | 213 | 74 | 34.74 | |||
| types of chronic diseases and comorbidities | suffer from hypertension alone | 173 | 60 | 34.68 | 34.992 | <0.01 |
| suffer from diabetic alone | 41 | 18 | 43.90 | |||
| suffer from cardiovascular and cerebrovascular diseases alone | 32 | 17 | 53.13 | |||
| suffer from musculoskeletal disease alone | 141 | 73 | 51.77 | |||
| suffer from respiratory disease alone | 37 | 24 | 64.86 | |||
| suffer from other chronic diseases alone | 192 | 94 | 48.96 | |||
| suffer from two kinds of chronic diseases simultaneously | 243 | 118 | 48.56 | |||
| suffer from three kinds of chronic diseases simultaneously | 94 | 47 | 50.00 | |||
| suffer from more than three chronic diseases simultaneously | 70 | 51 | 72.86 |
Analysis of factors influencing the utilization of TCM therapies among patients with chronic diseases of different characteristics
The use of TCM therapies by patients with chronic diseases was the dependent variable (0 = no, 1 = yes). Binary logistic regression analysis was conducted by using self-rated health status, the degree to which pain affects normal work, smoking status, the frequency of drinking, sleep quality, the frequency of seeking medical treatment, medical insurance status, media information sources, and the types of chronic diseases and comorbidities as independent variables. Furthermore, on the basis of epidemiological conventions, demographic variables such as sex, age, place of residence, and average monthly family income were forcibly included in the regression analysis process as confounding factors, regardless of the statistical significance of the χ2 tests. The binary logistic regression model was constructed by using the “input method”. The analysis process is as follows:
Multicollinearity assessment
Statistically significant independent variables and demographic variables were included as confounding factors in the binary logistic regression model for multicollinearity assessment. The results show the tolerance levels of sex, age, place of residence, average monthly family income, self-rated health status, the extent to which pain affects normal work, smoking status and drinking frequency, sleep quality, the frequency of medical visits in the past year, medical insurance status, media information sources, types of chronic diseases and comorbidities > 0.1 and the variance inflation factor (VIF) < 5. This indicates that there is no multicollinearity among the above factors, and they can be included in the binary logistic regression model for analysis, as shown in Table 4.
Table 4.
Multicollinearity Assessment.
| Variable | Tolerance | VIF | Variable | Tolerance | VIF |
|---|---|---|---|---|---|
| sex | 0.576 | 1.737 | frequency of drinking | 0.752 | 1.330 |
| age | 0.890 | 1.124 | sleep quality | 0.897 | 1.115 |
| place of residence | 0.846 | 1.181 | frequency of medical visits in the past year | 0.916 | 1.092 |
| average monthly family income | 0.863 | 1.159 | medical insurance status | 0.982 | 1.018 |
| self-assessed health status | 0.809 | 1.237 | media information sources | 0.828 | 1.207 |
| extent to which pain affects normal work | 0.981 | 1.019 | types of chronic diseases and comorbidities | 0.902 | 1.109 |
| smoking status | 0.596 | 1.677 |
Goodness-of-fit test
The degree of fit of the model was determined by referring to the results of the Hosmer–Lemeshow test. P = 0.545 > 0.05 indicated a good fit of the model.
The results revealed that factors such as age, self-assessed health status, frequency of drinking, frequency of medical visits in the past year, media information sources, and types of chronic diseases and comorbidities affected the use of TCM therapies by patients with chronic diseases. Specifically, compared with that among people over 81 years of age, the usage rate of TCM therapies was higher among those aged 41 ~ 60 years (OR = 1.978, 95%CI:1.069–3.663). Compared with patients with chronic diseases who do not drink alcohol, patients who drink several times a year or even less frequently had a higher utilization rate of TCM therapies (OR = 1.628, 95%CI:1.031–2.569). Compared with patients with chronic diseases who have never sought medical treatment in the past year, patients with a medical visit frequency of several times a week (OR = 2.888, 95%CI:1.047–7.966), approximately once a week (OR = 3.101, 95%CI:1.369–7.023), approximately once a month (OR = 1.988, 95%CI:1.239–3.190), and several times a year (OR = 1.734, 95%CI:1.202–2.502) had a higher utilization rate of TCM therapies. Compared with patients who believe that their health status is poor, patients who believe that their health status is average used TCM therapies to a lesser extent (OR = 0.709, 95%CI:0.504–0.996). Compared with patients with chronic diseases who obtained media information through more than three means, patients who only used television as the source of media information had a lower utilization rate of TCM therapies (OR = 0.624, 95%CI:0.410–0.948). Compared with patients who were suffering from more than three chronic diseases concurrently, patients with hypertension alone (OR = 0.260, 95%CI:0.134–0.507), diabetes alone (OR = 0.359, 95%CI:0.149–0.864), musculoskeletal diseases alone (OR = 0.466, 95%CI:0.237–0.917), other chronic diseases alone (OR = 0.367, 95%CI:0.191–0.706), and those suffering from two (OR = 0.394, 95%CI:0.212–0.732) or three chronic diseases concurrently (OR = 0.375, 95%CI:0.186–0.755) had a lower utilization rate of traditional Chinese medicine therapies. More details are shown in Table 5. In addition, a forest plot was drawn to present the research results of the influencing factors in a more intuitive manner. (Fig. 2)
Table 5.
Binary logistic regression analysis of the utilization of TCM therapies among patients with chronic diseases.
| Variable | Category | β | SE | Waldχ2 value |
P
value |
OR value | 95% CI |
|---|---|---|---|---|---|---|---|
| sex | male | −0.145 | 0.191 | 0.574 | 0.449 | 0.865 | 0.596–1.258 |
| female | — | — | — | — | 1.000 | — | |
| age | 40 years old and younger | 0.349 | 0.385 | 0.821 | 0.365 | 1.418 | 0.666–3.018 |
| 41–60 years old | 0.682 | 0.314 | 4.715 | 0.030 | 1.978 | 1.069–3.663 | |
| 61–80 years old | 0.541 | 0.293 | 3.403 | 0.065 | 1.718 | 0.967–3.052 | |
| 81 years and older | — | — | — | — | 1.000 | — | |
| place of residence | city | −0.070 | 0.152 | 0.212 | 0.645 | 0.933 | 0.693–1.255 |
| rural | — | — | — | — | 1.000 | — | |
| average monthly family income | 3000 yuan or less | −0.051 | 0.162 | 0.099 | 0.753 | 0.950 | 0.692–1.305 |
| 3001–6000 yuan | −0.152 | 0.193 | 0.620 | 0.431 | 0.859 | 0.588–1.254 | |
| 6001 yuan or above | — | — | — | — | 1.000 | — | |
| self-assessed health status | excellent | −0.772 | 0.571 | 1.832 | 0.176 | 0.462 | 0.151–1.413 |
| very good | −0.352 | 0.286 | 1.518 | 0.218 | 0.703 | 0.401–1.232 | |
| good | −0.189 | 0.268 | 0.494 | 0.482 | 0.828 | 0.489–1.402 | |
| general | −0.344 | 0.174 | 3.933 | 0.047 | 0.709 | 0.504–0.996 | |
| bad | — | — | — | — | 1.000 | — | |
| extent to which pain affects normal work | no effect | 0.118 | 0.253 | 0.216 | 0.642 | 1.125 | 0.685–1.849 |
| slight effect | 0.148 | 0.241 | 0.380 | 0.538 | 1.160 | 0.723–1.860 | |
| moderate effect | 0.223 | 0.273 | 0.670 | 0.413 | 1.250 | 0.733–2.133 | |
| a relatively large effect | −0.304 | 0.251 | 1.469 | 0.225 | 0.738 | 0.452–1.206 | |
| a very large effect | — | — | — | — | 1.000 | — | |
| smoking status | smoke now | −0.170 | 0.212 | 0.643 | 0.423 | 0.844 | 0.557–1.278 |
| used to smoke, but do not smoke now | 0.456 | 0.244 | 3.487 | 0.062 | 1.577 | 0.978–2.544 | |
| hardly/never smoke | — | — | — | — | 1.000 | — | |
| frequency of drinking | drink every day | −0.439 | 0.300 | 2.145 | 0.143 | 0.645 | 0.358–1.160 |
| several times during a week | −0.436 | 0.357 | 1.492 | 0.222 | 0.646 | 0.321–1.302 | |
| several times during a month | 0.207 | 0.295 | 0.491 | 0.483 | 1.230 | 0.690–2.192 | |
| a few times a year or even less | 0.487 | 0.233 | 4.379 | 0.036 | 1.628 | 1.031–2.569 | |
| no alcohol | — | — | — | — | 1.000 | — | |
| sleep quality | excellent | −0.025 | 0.294 | 0.007 | 0.933 | 0.976 | 0.548–1.736 |
| relatively good | −0.201 | 0.257 | 0.609 | 0.435 | 0.818 | 0.494–1.354 | |
| relatively poor | −0.033 | 0.261 | 0.016 | 0.899 | 0.967 | 0.580–1.613 | |
| very bad | — | — | — | — | 1.000 | — | |
| frequency of medical visits in the past year | several times during a week | 1.060 | 0.518 | 4.196 | 0.041 | 2.888 | 1.047–7.966 |
| about once a week | 1.132 | 0.417 | 7.361 | 0.007 | 3.101 | 1.369–7.023 | |
| about once a month | 0.687 | 0.241 | 8.117 | 0.004 | 1.988 | 1.239–3.190 | |
| several times during a year | 0.551 | 0.187 | 8.660 | 0.003 | 1.734 | 1.202–2.502 | |
| about once a year | 0.156 | 0.224 | 0.488 | 0.485 | 1.169 | 0.754–1.813 | |
| never | — | — | — | — | 1.000 | — | |
| medical insurance status | only public health insurance | −0.726 | 0.591 | 1.507 | 0.220 | 0.484 | 0.152–1.542 |
| public health insurance and commercial insurance | −0.095 | 0.637 | 0.022 | 0.882 | 0.909 | 0.261–3.168 | |
| no public health insurance | −0.649 | 0.671 | 0.938 | 0.333 | 0.522 | 0.140–1.944 | |
| uncertain | — | — | — | — | 1.000 | — | |
| media information sources | only through TV to obtain media information | −0.472 | 0.214 | 4.872 | 0.027 | 0.624 | 0.410–0.948 |
| only through internet to obtain media information | 0.256 | 0.439 | 0.341 | 0.559 | 1.292 | 0.547–3.056 | |
| only through other means to obtain media information | −0.284 | 0.422 | 0.452 | 0.502 | 0.753 | 0.329–1.723 | |
| through two ways to obtain media information | −0.082 | 0.192 | 0.183 | 0.669 | 0.921 | 0.632–1.342 | |
| through three ways to obtain media information | −0.339 | 0.204 | 2.758 | 0.097 | 0.713 | 0.478–1.063 | |
| through more than three ways to obtain media information | — | — | — | — | 1.000 | — | |
| types of chronic diseases and comorbidities | suffer from hypertension alone | −1.345 | 0.340 | 15.67 | <0.001 | 0.260 | 0.134–0.507 |
| suffer from diabetic alone | −1.023 | 0.448 | 5.223 | 0.022 | 0.359 | 0.149–0.864 | |
| suffer from cardiovascular and cerebrovascular diseases alone | −0.688 | 0.474 | 2.104 | 0.147 | 0.503 | 0.198–1.273 | |
| suffer from musculoskeletal disease alone | −0.764 | 0.345 | 4.887 | 0.027 | 0.466 | 0.237–0.917 | |
| suffer from respiratory disease alone | −0.177 | 0.470 | 0.142 | 0.706 | 0.838 | 0.333–2.105 | |
| suffer from other chronic diseases alone | −1.003 | 0.334 | 9.009 | 0.003 | 0.367 | 0.191–0.706 | |
| suffer from two kinds of chronic diseases simultaneously | −0.931 | 0.316 | 8.693 | 0.003 | 0.394 | 0.212–0.732 | |
| suffer from three kinds of chronic diseases simultaneously | −0.980 | 0.357 | 7.541 | 0.006 | 0.375 | 0.186–0.755 | |
| suffer from more than three chronic diseases simultaneously | — | — | — | — | 1.000 | — |
Fig. 2.
Logistic regression forest plot of factors affecting the use of TCM therapies by patients with chronic diseases.
Discussion
In recent years, numerous studies have confirmed that TCM therapies have unique advantages in the prevention and treatment of diverse medical conditions16–19. Research has revealed that nearly 50% of middle-aged and elderly people in China tend to use TCM therapies, and the characteristic of suffering from chronic diseases is the main factor affecting the use of TCM therapies by this group of people20. In addition, a study in Iran21 confirmed that the use of traditional Chinese herbal medicine and acupuncture to treat chronic diseases is very popular among patients with cardiovascular diseases, which also provides an empirical basis and application ideas for the prevention and treatment of chronic diseases with TCM therapies. However, the above mentioned studies have not yet systematically identified the relevant decision-making factors that influence the choice of TCM therapies by patients who have chronic diseases. Therefore, this study applied nationally representative datasets from China to delve into the factors that influence the adoption of TCM therapies by patients who have chronic diseases to explore ways to further enhance the awareness and utilization of TCM therapies among patients with chronic diseases worldwide.
Our research revealed that among the included patients with chronic diseases, the utilization rate of TCM therapies in general was 49.07%. These data indicate that, driven by relevant TCM policies and prevailing trends, the chronic disease population has a certain degree of recognition of the ability of TCM therapies to improve health status and quality of life, which is consistent with the findings of Zhang X et al.22. However, since only around half of the chronic disease population uses TCM, this implies that there is still considerable room for improvement in the utilization rate of TCM therapies among patients with chronic diseases. Among the six types of TCM therapies covered in this study, the utilization rate of Chinese herbal medicine treatment was the highest (73.11%). Compared with Chinese herbal medicine treatment, other TCM therapies, including acupuncture, moxibustion, cupping therapy, finger pressure therapy, and massage, are special TCM therapies that require services provided by professional institutions or health care professionals; thus, their accessibility is relatively limited, leading to a relatively lower utilization rate. Therefore, enhancing the accessibility and acceptability of special TCM therapies, encouraging TCM scholars from different countries to further study and apply these therapies, increasing the promotion and recognition of special TCM therapies, and promoting their widespread application in chronic disease management are necessary.
Furthermore, research shows that there is no significant urban‒rural difference in the proportion of people with chronic diseases using TCM therapies, indicating its balanced popularization in urban and rural prevention and treatment. This is attributed to the effective promotion of TCM policies in China and the universal value of TCM. Given the uneven distribution of medical resources between urban and rural areas worldwide, TCM therapies offer a Chinese solution for narrowing the medical gap between urban and rural areas and provide empirical evidence for the assistance of TCM therapies in chronic disease health management globally.
Our research further revealed that age, self-rated health status, the frequency of drinking, the frequency of medical visits in the past year, media information sources, types of chronic diseases and comorbidities are factors influencing the use of TCM therapies among patients with chronic diseases. Specifically, patients who aged 41–60 years, who have chronic diseases and who drink alcohol a few times a year or even less and those who have medical visits several times a week, approximately once a week, approximately once a month, or several times a year tend to have a higher utilization rate of TCM therapies. This may be attributed to the stronger health awareness among this group, which prompts a higher overall utilization of medical services and, consequently, a higher frequency of TCM therapy use. The utilization rate of TCM therapies is lower among patients with chronic diseases whose self-assessed health status is normal than among those whose self-assessed health status is poor. This should be attributed to relatively healthy people directing a lower level of attention toward different chronic disease therapies, their lesser enthusiasm for seeking help from TCM therapies, and their understanding of the characteristics of TCM, which include having a gentler regulatory effect23,24 and being relatively less burdensome to the body. Compared with residents with diverse media usage, patients with chronic diseases who obtained media information only through TV exhibit a lower utilization rate of TCM therapies. This is likely due to their limited access to media sources, which hinders their acquisition of more comprehensive knowledge about TCM therapies, thus resulting in a lower utilization rate. Compared with patients who suffered from more than three chronic diseases simultaneously, patients with a single condition, such as hypertension, diabetes, musculoskeletal diseases, or other chronic diseases, as well as those with two or three chronic diseases simultaneously, exhibited a lower utilization rate of TCM therapies. This may be attributed to the fact that the greater the number of chronic diseases, the greater the complexity of their health status, leading to a greater likelihood of selecting different TCM therapy options. Consequently, patients with fewer chronic diseases tend to have a lower utilization rate of TCM therapies. Additionally, existing research has shown that TCM therapies, characterized by their simplicity, accessibility, and low cost, have become one of the distinctive tools for the prevention and treatment of chronic disease comorbidities. They can comprehensively improve overall health, which is also one of the reasons for the higher utilization rate of TCM therapies among patients with more chronic diseases25,26.
Yu Yanhong, director of the National Administration of Traditional Chinese Medicine of China, mentioned at the side event “Traditional Medicine” of the World Health Assembly that the Chinese government attaches great importance to the development of TCM and gives full play to the advantages and potential of traditional medicine in primary health care and universal health coverage. China has been closely cooperating with the World Health Organization and has included a chapter on traditional medicine in the 11th Revision of the International Classification of Diseases for the first time. At present, TCM has spread to 196 countries and regions, effectively contributing to the building of a community of health for humanity27. Additionally, according to statistics, 113 member countries of the World Health Organization have recognized the use of acupuncture, and the International Organization for Standardization has established the Traditional Chinese Medicine Technical Committee (ISO/TC249) to formulate and promulgate over 110 international standards for traditional Chinese medicine. Therefore, the use of TCM therapies for health care will be widely popular among patients with chronic diseases.
Notably, in China, the innovative strategies and practical experiences of TCM therapies in the prevention and treatment of chronic diseases are particularly valuable for reference. The Healthy China Initiative (2019–2030) policy28 provides clear guidance for the prevention and treatment of several major chronic diseases. For example, in cancer prevention and treatment, innovative integration of traditional Chinese medicine with modern technology has been employed; for chronic respiratory diseases, distinctive TCM services such as “Sanfu Paste” therapy have been promoted. On the basis of the above research results and relevant policies, we propose the following suggestions. First, we recommend leveraging modern communication methods to strengthen the promotion and dissemination of TCM therapies. This can be achieved by utilizing “Internet+” methodologies29 to establish a dissemination matrix related to TCM therapies. By creating online and offline promotional platforms for TCM health preservation and wellness, we can expand the reach of TCM therapies, increase the awareness and utilization rate of TCM therapies among the global chronic disease population regarding their advantages in preventing and treating chronic diseases, increase patients’ awareness of TCM therapies, foster and optimize health-related behaviors among patients with chronic diseases, promote the use of TCM therapies among patients with mild chronic conditions, and motivate patients with chronic diseases to actively adopt TCM therapies. Additionally, through the snowball effect among patients30, we can leverage the approach of “patients attracting other patients” to achieve the goal of “leading to the formation of groups”. In the process of motivation and practice, the work and service capabilities of scholars and technicians in TCM around the world can be enhanced.
On the basis of the advantages and high level of attention that TCM therapies have demonstrated in recent years, governments and their health departments around the world should prioritize the introduction and use of various TCM therapies. Importantly, strengthening the supervision of the application scope of TCM therapies and effectively managing the ethical norms governing their use in the field of chronic diseases are crucial. Moreover, in light of the World Health Organization’s emphasis on vigorously promoting primary health care and considering that most chronic diseases are characterized by their prolonged duration31 and can be effectively managed at the grassroots level32, we propose strengthening the capacity building of TCM services within the primary health care systems of various countries, enhancing the ability of primary health care institutions to guide patients with chronic diseases in utilizing TCM therapies, gradually achieving a favorable situation where “TCM therapies support the prevention and treatment of chronic diseases at the grassroots level, and assist in the rehabilitation of chronic diseases at the grassroots level”33. Furthermore, establishing reimbursement policies for TCM therapies that are compatible with the medical insurance systems of various countries and incorporating a diverse range of TCM therapies into the reimbursement scope to alleviate the economic burden on patients with chronic diseases34 are key factors in promoting the widespread application of TCM therapies in the prevention and treatment of chronic diseases worldwide.
Conclusion
Chinese patients with chronic conditions have a certain level of recognition of the use of TCM therapies in personal health management, but further improvements are still needed. The willingness of patients to adopt TCM therapies is influenced by various types of factors, including age, self-assessed health status, frequency of drinking, frequency of medical visits in the past year, media information sources, and types of chronic diseases and comorbidities. The findings of this research provide certain reference significance for promoting the popularity of TCM therapies worldwide and offering more diverse health management options for patients with chronic conditions in various countries. First, it is necessary to fully grasp the innovative trends in the application of TCM therapies for chronic disease management and strengthen their promotion and recognition globally. Second, it is important to focus on the key influencing factors and increase the willingness of patients with chronic diseases in various countries to adopt TCM therapies for health management.
Limitations
The limitation of this study is that it is a cross-sectional study, and as such, it is currently unable to determine the causal relationship and mechanism between the use of TCM therapies among patients with chronic diseases and the influencing factors. In addition, this questionnaire did not cover important items such as the accessibility of TCM therapies for people with chronic diseases and their cultural attitudes toward TCM, resulting in a lack of discussion on this confounding factor in this study. In the future, a cohort study or field research based on this study should be conducted to explore the potential factors influencing the use of TCM therapies among patients with chronic diseases and to assess their development trends. The aim is to provide more theoretical support for optimizing the further globalization of TCM in the prevention and treatment of chronic diseases.
Acknowledgements
We sincerely grateful the CGSS database. And the author wants to express gratitude to all participants in this study.
Abbreviations
- TCM
Traditional Chinese Medicine
- CGSS2021
China General Social Survey of 2021
Author contributions
YF.C : Article conception and writing, data collection and sorting, statistical analysis.T.H，HY. D，JY.Z，FJ.G : Data collection and collation, statistical analysis. WQ.Y，JW. H，ZM. C : Paper revision. HW. G : Article conception and writing, article quality control and review, overall responsibility for the article, supervision and management.All authors have made significant contributions to this study and have reviewed the manuscript.
Funding
This work has been funded by the Natural Science Foundation of Shandong Province [grant numbers ZR2020MG055].
Data availability
All the data files can be obtained from the CGSS database (http://www.cnsda.org/index.php?r=projects/view&id=65635422).
Declarations
Ethics approval and consent to participate
This study does not involve any ethical issues. We used the public datasets of CGSS2021 which does not need additional ethics approval.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All the data files can be obtained from the CGSS database (http://www.cnsda.org/index.php?r=projects/view&id=65635422).