Changing spectrum and mortality disparities of etiology of liver cirrhosis in Beijing, China.

Liver cirrhosis remains a major health concern globally, but its epidemiology and etiology evolve with time. However, the changing pattern in etiology and cause of liver-related mortality for patients with cirrhosis are not fully elucidated. Herein, our aim was to characterize the temporal trend of the etiological spectrum and evaluate the impact of etiology on liver-related death among patients with compensated cirrhosis (CC) in Beijing, China. Clinical profiles of patients with CC discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. The mortalities of different etiologies of cirrhosis were calculated. The risks of readmission and liver-related death associated with etiologies were evaluated by the Cox regression model. A total of 23 978 cirrhotic patients were included. The predominant cause was hepatitis B virus (HBV) (58.93%), followed by alcohol (21.35%), autoimmune (14.85%), miscellaneous etiologies (3.55%), and hepatitis C virus (HCV) (1.32%). From 2008 to 2015, the proportion of HBV-related cirrhosis decreased to 28.11%. Meanwhile, the proportions of autoimmune- and miscellaneous-related cirrhosis increased to 28.54% and 13.11%. The risk of liver-related death ranked the highest in patients with miscellaneous cirrhosis, followed by HBV-related cirrhosis, alcohol-related cirrhosis, autoimmune-related cirrhosis, and HCV-related cirrhosis. The 5-year rates of liver-related death were 22.56%, 18.99%, 18.77%, 16.01%, and 10.76%, respectively. HBV-related cirrhosis caused the highest risk of hepatocellular carcinoma (HCC)-related death, whereas alcohol- and miscellaneous-related cirrhosis caused higher risks of decompensation (DC)-related death than HBV-related cirrhosis, with hazard ratios of 1.35 (95% confidence interval [CI]: 1.24-1.48) and 1.20 (95% CI: 1.03-1.40), respectively. HBV remained a common cause of liver cirrhosis but gradually decreased. Mortality disparities existed in etiologies, with higher risks of HCC-related death in HBV-related cirrhosis, and DC-related death in alcohol- and miscellaneous-related cirrhosis.

Synergistic toxicity of some food additives used in non-alcoholic beverages on renal tubular epithelial cells.

Evidences supported many food additives (FAs) possess toxicity to human health due to chronic excessive exposure. Global hygienic standards strictly limit the dosage of each FA and mixture of the same functional FAs. However, the synergetic effects caused by the combination of FAs with different functions require careful evaluation. In the present study, the content of each FA in beverages was determined by HPLC-UV-Vis detection. The cytotoxic effects of selected typical FAs alone or their combination were evaluated in human renal tubular epithelial cells. Mathematical Modeling and bioinformatics methods were employed to evaluate the toxicity of FAs and to predict the key target proteins of FAs on renal tubular cell toxicity, which were verified by western blot. The results indicated above 5 FAs were used in each surveyed beverage. The content of each FA and the respective ratios of the same functional FAs in each beverage did not exceed the maximum permitted level. But it was intensively shown that the significant synergistic cytotoxicity for the combination of FAs with lower concentration. The intercellular signaling transduction pathways including JNK/STAT, PI3P/AKT, and MAPK pathways, which could also be activated by PDGF signaling, were predicted to be involved in Fas-induced cytotoxicity. The increased expression of p-STAT3, p-JNK and p-AKT was associated with renal tubular injury. The current study implied the synergistic cytotoxic effect caused by multiple FAs at no toxic dosages via activated cellular transduction pathways regulating cell survival and apoptosis function, which warning of the synergistic toxic effects of different types of FAs.

Prevalence of Metabolic Syndrome and Risk Factors Among Chinese Adults: Results from a Population-Based Study - Beijing, China, 2017-2018.

What is already known about this topic?: Metabolic syndrome (MetS) is one of the most easily available health indicative markers for cardiovascular diseases, and it has become a major public health problem worldwide due to increasing urbanization and aging populations. The prevalence of MetS increased dramatically in China, however, there are no records of MetS defined by the 2017 Chinese Diabetes Society for Beijing by far. What is added by this report?: In this study, the data of 24,412 participants aged 18-74 years from a large population-based study in Beijing was collected. The overall prevalence of MetS among Beijing residents was 24.5%. The prevalence was 35.2% in males and 15.4% in females. What are the implications for public health practice?: Effective public health strategies should target males, people with older age, lower education, higher body mass index, smokers, those who drink alcohol, those who are unemployed or retired, and those who live in rural areas on MetS prevention and control.

Characteristics of Lung Function and Prevalence of Airflow Obstruction Among Individuals Aged 18-74 Years - Beijing, China, 2017-2018.

What is already known about this topic?: Airflow obstruction is the hallmark of many chronic respiratory diseases and may indicate the potential for the development of other progressive diseases. There are currently no representative studies of lung function in Beijing. An up-to-date estimation of the characteristics of lung function and airflow obstruction is thus needed. What is added by this report?: The estimated prevalence of airflow obstruction was 14.68% in Beijing, 2017-2018. The values of vital capacity, forced vital capacity, and forced expiratory volume in the first second were 3.09 L, 2.66 L, 2.22 L, respectively. What are the implications for public health practice?: Effective public health strategy for lung in Beijing should target older people, current or former smokers, and individuals who live in urban environments, have a low education level, exhibit a high smoking index, and/or have an abnormal body mass index.

Associations of long-term exposure to air pollution with blood pressure and homocysteine among adults in Beijing, China: A cross-sectional study.

BACKGROUND: Studies on the hypertensive effect of long-term exposure to air pollution are mixed, and sparse evidence exists regarding its effects on homocysteine (Hcy), another crucial risk factor for cardiovascular disease (CVD). METHODS: We collected data from 23,256 participants aged 18-74 years at baseline (years 2017-2018) from a community-based cohort in China. A linear combination of concentrations from monitoring stations at the participants' home and work addresses, weighted by the time, was used to estimate two-year exposures to particulate matter with fine particles≤2.5 µm (PM2.5), aerodynamic diameter≤10 µm (PM10), nitrogen dioxide (NO2) and sulfur dioxide (SO2). Generalized linear regressions and logistic regressions were conducted to examine the associations between air pollution and systolic blood pressure (SBP), diastolic blood pressure (DBP), Hcy, hypertension and co-occurrence of hypertension and hyperhomocysteinemia (HHcy). RESULTS: The results showed that each interquartile range (IQR) increase in PM2.5 (16.1 µg/m3), PM10 (19.3 µg/m3) and SO2 (3.9 µg/m3) was significantly associated with SBP (changes: 0.64-1.86 mmHg), DBP (changes: 0.35-0.70 mmHg) and Hcy (changes: 0.77-1.04 µmol/L) in the fully adjusted model. These air pollutants were also statistically associated with the prevalence of co-occurrence of hypertension and HHcy (ORs: 1.22-1.32), which were stronger than associations with the prevalence of hypertension (ORs: 1.09-1.19). The hypertensive effects of exposure to PM2.5, PM10 and SO2 were more pronounced among elder participants, obese participants, those with established CVD or a high 10-year CVD risk and those with a family history of hypertension. However, interaction analyses of Hcy showed different patterns. Additionally, moderate level of physical activity and active travel mode benefited individuals in resisting the health impacts of air pollution on both blood pressure (BP) and Hcy. CONCLUSIONS: Our study supports a positive relationship between air pollution and BP and Hcy among adults in Beijing, and close attention to vulnerable populations and healthy lifestyles could effectively benefit further cardiovascular health.

Influenza-associated cardiovascular mortality in older adults in Beijing, China: a population-based time-series study.

OBJECTIVE: This study comprehensively estimated the excess cardiovascular disease (CVD) mortality attributable to influenza in an older (age ≥65 years) population. DESIGN: Ecological study. SETTING: Aggregated data from administrative systems on CVD mortality, influenza surveillance and meteorological data in Beijing, China. MAIN OUTCOME MEASURE: Excess overall CVD, and separately for ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke mortality attributable to influenza, adjusting for influenza activity, time trend, seasonality and ambient temperature. RESULTS: CVD (risk ratio (RR) 1.02, 95% CI 1.01, 1.02), IHD (RR 1.01, 95% CI 1.01, 1.02), ischaemic stroke (RR=1.03, 95% CI 1.02, 1.04), but not haemorrhagic stroke (RR=1.00, 95% CI 0.99, 1.01) mortality, were significantly associated with every 10% increase in influenza activity. An increase in circulating A(H1N1)09pdm, A(H3N2) and B type virus were all significantly associated with CVD and ischaemic stroke mortality, but only A(H3N2) and B type virus with IHD mortality. The strongest increase in disease mortality was in the same week as the increase in influenza activity. Annual excess CVD mortality rate attributable to influenza ranged from 54 to 96 per 100 000 population. The 3%-6% CVD mortality attributable to influenza activity was related to an annual excess of 916-1640 CVD deaths in Beijing, China. CONCLUSIONS: Influenza activity has moderate to strong associations with CVD, IHD and ischaemic stroke mortality in older adults in China. Promoting influenza vaccination could have major health benefit in this population. BACKGROUND: Influenza may trigger serious CVD events. An estimation of excess CVD mortality attributable to influenza has particular relevance in China where vaccination is low and CVD burden is high. METHODS: This study analysed data at the population level (age ≥65 years) using linked aggregated data from administrative systems on CVD mortality, influenza surveillance and meteorological data during 2011 to 2018. Quasi-Poisson regression models were used to estimate the excess overall CVD, and separately for IHD, ischaemic stroke, haemorrhagic stroke mortality attributable to influenza, adjusting for influenza activity, time trend, seasonality and ambient temperature. Analyses were also undertaken for influenza subtypes (A(H1N1)09pdm, A(H3N2) and B viruses), and mortality risk with time lags of 1-5 weeks following influenza activity in the current week.

A new method to estimate the temperature-CVD mortality relationship.

Few detailed, individual-focused studies have researched the added effect of temperature on cardiovascular disease (CVD), particularly in China. Moreover, no prior studies have explored the exposure-response relationship among all populations and different sub-sociodemographic groups. A distributed lag nonlinear model (DLNM) was applied to evaluate the adverse health effects of temperature on CVD mortality for all populations and different sub-sociodemographic groups (by age, sex, educational level, living arrangement, and occupation) in Beijing. Based on the exposure-response relationships, firstly, we proposed a new model (COCKTAIL, Code Of Climate Key To An Ill) for revealing the split-and-merge relationships of the temperature-CVD mortality curve. This method could be used to apply the CVD deaths in a studied area to forecast the exposure-response relationships in the same area in the future. Secondly, this is the most detailed study to analyze the relationship between temperature and CVD mortality for different subgroups among the existing researches for developed and developing countries. We found that the cold temperature (at - 14 °C) was the risk factor for people with low socioeconomic status, especially for single people (including unmarried, divorced, and widowed), for indoor workers, and for people with low education, compared with the minimum mortality temperature, with a cumulative increase of 3.9 (80%CI, 2.9-5.4), 3.8 (80%CI, 2.8-5.1), and 4.5 (80%CI, 3.1-6.3) times respectively. Meanwhile, the hot temperature (at 35 °C) was the risk factor for CVD death, with a cumulative increase of 2.6 (80%CI, 2.0-3.4) for females, and 3.1 (80%CI, 2.4-4.2) for single people. The varying CVD vulnerability in terms of CVD mortality among various groups may assist governments in preparing health resources and taking measures to prevent or reduce temperature-related deaths.

Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007-2013.

BACKGROUND: Data about influenza mortality burden in northern China are limited. This study estimated mortality burden in Beijing associated with seasonal influenza from 2007 to 2013 and the 2009 H1N1 pandemic. METHODS: We estimated influenza-associated excess mortality by fitting a negative binomial model using weekly mortality data as the outcome of interest with the percent of influenza-positive samples by type/subtype as predictor variables. RESULTS: From 2007 to 2013, an average of 2375 (CI 1002-8688) deaths was attributed to influenza per season, accounting for 3% of all deaths. Overall, 81% of the deaths attributed to influenza occurred in adults aged ≥65 years, and the influenza-associated mortality rate in this age group was higher than the rate among those aged <65 years (113.6 [CI 49.5-397.4] versus 4.4 [CI 1.7-18.6] per 100 000, P < .05). The mortality rate associated with the 2009 H1N1 pandemic in 2009/2010 was comparable to that of seasonal influenza during the seasonal years (19.9 [CI 10.4-33.1] vs 17.2 [CI 7.2-67.5] per 100 000). People aged <65 years represented a greater proportion of all deaths during the influenza A(H1N1)pdm09 pandemic period than during the seasonal epidemics (27.0% vs 17.7%, P < .05). CONCLUSIONS: Influenza is an important contributor to mortality in Beijing, especially among those aged ≥65 years. These results support current policies to give priority to older adults for seasonal influenza vaccination and help to define the populations at highest risk for death that could be targeted for pandemic influenza vaccination.

Willingness to accept a future influenza A(H7N9) vaccine in Beijing, China.

BACKGROUND: The present study aimed to estimate residents' willingness to accept a future H7N9 vaccine and its determinants in the general adult population in Beijing, China. METHODS: We conducted a multi-stage sampling, cross-sectional survey using self-administered anonymous questionnaires from May to June, in 2014. The main outcome variable was residents' willingness to accept a future H7N9 vaccine. Logistic regression was used to identify the predictors of vaccination willingness. RESULTS: Of the 7264 eligible participants, 14.5% of Beijing residents reported that they had not heard of H7N9. Among those who had heard of H7N9, 59.5% of the general adult population would be willing to accept a future H7N9 vaccine, and approximately half of them reported 'I am afraid of being infected by H7N9' and 'H7N9 vaccine can prevent infections', and 28.1% reported 'my daily life is affected by H7N9'. The variables that were significantly associated with a higher likelihood of reporting willingness were being younger adults (aged 18-29 years: OR = 1.52, 95% CI: 1.17-1.97; aged 30-39 years: OR = 1.39, 95% CI: 1.08-1.78), being farmers (OR = 1.61; 95% CI: 1.32-1.96), being unemployed people (OR = 1.36; 95% CI: 1.04-1.78), living in suburban areas (OR = 2.18; 95% CI: 1.89-2.51), having ≥2 children in the family (OR = 1.41; 95% CI: 1.03-1.92), perceived risk in China (OR = 1.30; 95% CI: 1.15-1.48), perceived susceptibility to disease (OR = 3.13; 95% CI: 2.73-3.58), perceived negative effect on daily life (OR = 1.32; 95% CI: 1.13-1.55), perceived effectiveness of vaccination (OR = 2.34; 95% CI: 2.07-2.64), and recent uptake of influenza vaccine (OR = 2.26; 95% CI: 1.92-2.66). CONCLUSIONS: A great number of Beijing residents had doubts about the vaccine's effectiveness and were not concerned about disease risk, which were the factors affecting willingness to be vaccinated. Targeted education programs on disease risk as well as vaccine's effectiveness are needed to improve the willingness of vaccination for potential H7N9 pandemic preparedness.

Factors associated with the uptake of seasonal influenza vaccination in older and younger adults: a large, population-based survey in Beijing, China.

OBJECTIVES: The present study aimed to estimate the influenza vaccination coverage rate in Beijing, China, and identify its determinants in older and younger adults. METHODS: A survey was conducted among Chinese adults using a self-administered, anonymous questionnaire in May-June 2015. The main outcome was seasonal influenza vaccination uptake. Multivariate logistic regression models were performed to identify factors associated with uptake. RESULTS: A total of 7106 participants completed the questionnaire. The overall coverage rate was 20.6% (95% CI 19.7% to 21.5%) in the 2014/2015 influenza season. Lower education (older adults: OR 1.6; 95% CI 1.2 to 2.1; younger adults: OR 1.9; 95% CI 1.4 to 2.6), having a chronic illness (older adults: OR 1.9; 95% CI 1.5 to 2.4; younger adults: OR 1.4; 95% CI 1.2 to 1.7) and recommendations from healthcare workers (older adults: OR 5.4; 95% CI 3.9 to 7.4; younger adults: OR 4.5; 95% CI 3.7 to 5.4) were positively associated with uptake; perceived side effects of vaccination had a negative impact (older adults: OR 0.6; 95% CI 0.4 to 0.7; younger adults: OR 0.8; 95% CI 0.7 to 1.0). Perceived susceptibility to influenza (OR 1.5; 95% CI 1.2 to 2.0) and awareness of the free influenza vaccine policy (OR 1.9; 95% CI 1.2 to 2.9) were only associated with vaccine uptake in older adults, while perceived effectiveness of vaccination (OR 2.2; 95% CI 1.7 to 2.8) was only a predictor for younger adults. Older adults were more likely to receive recommendations from healthcare professionals and perceive the severity of seasonal influenza, and less likely to worry about side effects of vaccination. CONCLUSION: The influenza vaccination coverage rate was relatively low in Beijing. Apart from free vaccinations for older adults, age disparity in the rate between older and younger adults (48.7% vs 16.0%) may be explained by differing professional recommendations and public perceptions. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years.

[Decomposition of life expectancy among permanent residents of Beijing, 2000 - 2010].

OBJECTIVE: To analyze the change of life expectancy and the impact of mortality by age and causes of death on this issue among permanent residents of Beijing. METHODS: Abridged Life Table and Arriaga method were used to calculate and to decompose the changes on life expectancy by age and causes of death in 2000 - 2010. RESULTS: From 2000 - 2010, life expectancy under this studied population had an increase of 3.35 years. Most part of the increases (44.27%, 1.48 years) within the last 10 years could be explained by the decrease of mortality in the population at age ≥ 80. Both cerebrovascular and heart diseases were contributing the most to the increment of life expectancy while mortality of malignant tumors appeared a negative contributor to this increment. CONCLUSION: From 2000 to 2010, increment in life expectancy contributed to the decrease of mortality in the elderly and the decrease of mortalities on both cardio- and cerebro-vascular diseases. The decrease of life expectancy was mainly due to the increase of mortality related to malignant tumors.

[Characteristics of out-of-hospital acute coronary heart disease deaths of Beijing permanent residents at the age of 25 or more from 2007 to 2009].

OBJECTIVE: To analyze the characteristics of out-of-hospital acute coronary heart disease (CHD) deaths in Beijing permanent residents at the age of 25 or more from 2007 to 2009. METHODS: We analyzed the gender, age, geographical distribution, occupation, marital status and the extent of different education characteristics of out-of-hospital acute CHD deaths of the Beijing permanent residents at the age of 25 or more from 2007 to 2009 using the mortality information database from the Beijing Vital Registration Monitoring System. RESULTS: Of the total 41 732 acute CHD deaths, 30 159 (72.27%) died out of hospital and out-of-hospital mortality was 2.61 times higher than in-hospital mortality. Majority out-of-hospital death occurred in males (72.30%, 16 068/22 224), in 25 - 34 years old people (91.75%, 89/97), in residents living in remoter suburbs and counties (82.43%, 13 513/16 393), in rural population (89.50%, 10 017/11 192), in non-marital single (80.76%, 592/733) and in people less than five-years of schooling (83.95%, 11 388/13 565). Most out-of-hospital acute CHD death occurred at home (78.80%, 23 765/30 159). CONCLUSIONS: Out-of hospital acute CHD mortality is high in Beijing permanent residents at the age of 25 and over from 2007 to 2009. Male, 25 - 34 years old, living in outer suburbs and counties, rural population, non-marital single, and less education years are major risk factors for out-of-hospital acute CHD death.