Article Text

Original research
Disease composition and epidemiological characteristics of primary care visits in Pudong New Area, Shanghai: a longitudinal study, 2016–2018
  1. Xin Gong1,
  2. Xiaoli Wang2,
  3. Tianxing Shi2,
  4. Jianwei Shi3,
  5. Wenya Yu3,
  6. Liang Zhou3,
  7. Ning Chen4,
  8. Jiaoling Huang3,5,
  9. Zhaoxin Wang3
  1. 1Heart Failure Department, Shanghai East Hospital affiliated to Tongji University School of Medicine, Shanghai, China
  2. 2Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
  3. 3School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  4. 4School of Medicine, Tongji University, Shanghai, China
  5. 5Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
  1. Correspondence to Dr Jiaoling Huang; jiaoling_huang{at}; Dr Zhaoxin Wang; supercell002{at}


Objectives This study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed.

Setting We extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre.

Participants Our data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong.

Results We found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits—a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age.

Conclusions Different from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.

  • primary care
  • epidemiology
  • public health

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  • JH and ZW contributed equally.

  • Contributors ZW conceived and designed the study. XW, JS, TS and WY were involved with data collection. JH, LZ and NC analysed the data. XG and JH wrote the article.

  • Funding This work was supported by the National Natural Science Foundation of China (71744116, 71904145, 71603182, 71804128), the National Key Research and Development Program of China (2018YFC2000700, SQ2018YFC130057) and the Shanghai Pujiang Program (2019PJC072).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the ethics committees of Shanghai Tenth People’s Hospital (ref: 2019-K173-02). The research presented minimal risk of harm to participants, and the study only included primary care visits data collected anonymously.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data generated and analysed during the present study are only for academic use and are not publicly available because of patient privacy proctection. However, they are available from the corresponding author ( for researchers who meet the criteria for access to confidential data.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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