Advancing Underlying Cause of Death Inference Through Wide and Deep Model.

Introduction: Accurately filling out death certificates is essential for death surveillance. However, manually determining the underlying cause of death is often imprecise. In this study, we investigate the Wide and Deep framework as a method to improve the accuracy and reliability of inferring the underlying cause of death. Methods: Death report data from national-level cause of death surveillance sites in Fujian Province from 2016 to 2022, involving 403,547 deaths, were analyzed. The Wide and Deep embedded with Convolutional Neural Networks (CNN) was developed. Model performance was assessed using weighted accuracy, weighted precision, weighted recall, and weighted area under the curve (AUC). A comparison was made with XGBoost, CNN, Gated Recurrent Unit (GRU), Transformer, and GRU with Attention. Results: The Wide and Deep achieved strong performance metrics on the test set: precision of 95.75%, recall of 92.08%, F1 Score of 93.78%, and an AUC of 95.99%. The model also displayed specific F1 Scores for different cause-of-death chain lengths: 97.13% for single causes, 95.08% for double causes, 91.24% for triple causes, and 79.50% for quadruple causes. Conclusions: The Wide and Deep significantly enhances the ability to determine the root causes of death, providing a valuable tool for improving cause-of-death surveillance quality. Integrating artificial intelligence (AI) in this field is anticipated to streamline death registration and reporting procedures, thereby boosting the precision of public health data.

Long-term exposure to PM2.5 chemical constituents and diabesity: evidence from a multi-center cohort study in China.

Background: Long-term exposure to PM2.5 is known to increase the risks for diabetes and obesity, but its effects on their coexistence, termed diabesity, remain uncertain. This study aimed to investigate the associations of long-term exposure to PM2.5 and its chemical constituents with the risks for diabesity, diabetes, and obesity. Methods: This cross-sectional study used the baseline data of a multi-center cohort, consisting of three provincially representative cohorts comprising a total of 134,403 participants from the eastern (Fujian Province), central (Hubei Province), and western (Yunnan Province) regions of China. Obesity and diabetes, and diabesity were identified by a body mass index (BMI) ≥28 kg/m2 and fasting plasma glucose (FPG) ≥126 mg/dL. The average concentrations of PM2.5 and five chemical constituents (NO3 -, SO4 2-, NH4 +, organic matter, and black carbon) over participants' residence during the past three years were estimated using machine learning models. Logistic regression models with double robust estimators, Bayesian kernel machine regression, and weighted quantile sum regression were employed to estimate independent and joint effects of PM2.5 chemical constituents on the risks for diabesity, diabetes, and obesity, as well as the differences from the effects on obesity. Stratified analyses were performed to examine effect modification of sociodemographic and lifestyle factors. Findings: There were 129,244 participants with a mean age of 54.1 ± 13.8 years included in the study. Each interquartile range increase in PM2.5 concentration (8.53 µg/m3) was associated with an increased risk for diabesity (OR = 1.23 [1.17, 1.30]), diabetes only (OR = 1.16 [1.13, 1.19]), and obesity only (OR = 1.03 [1.00, 1.05]). Long-term exposure to each PM2.5 chemical constituent was associated with an increased risk for diabesity, where organic matter exposure, with maximum weight (48%), was associated with a higher risk for diabesity (OR = 1.21 [1.16, 1.27]). Among those with obesity, black carbon contributed most (68%) to the joint effect of PM2.5 chemical constituents on diabesity (OR = 1.16 [1.11, 1.22]). Physical activity reduced adverse effects of PM2.5 on diabesity. Also, additive rather than multiplicative effects of obesity on the PM2.5-diabetes association were observed. Interpretation: Long-term exposure to PM2.5 and its chemical constituents was associated with an increased risk for diabesity, stronger than associations for diabetes and obesity alone. The main constituents associated with diabesity and obesity were black carbon and organic matter. Funding: National Natural Science Foundation of China (42271433, 723B2017), National Key R&D Program of China (2023YFC3604702), Fundamental Research Funds for the Central Universities (2042023kfyq04, 2042024kf1024), the Science and Technology Major Project of Tibetan Autonomous Region of China (XZ202201ZD0001G), Science and technology project of Tibet Autonomous Region（XZ202303ZY0007G), Key R&D Project of Sichuan Province (2023YFS0251), Renmin Hospital of Wuhan University (JCRCYG-2022-003), Jiangxi Provincial 03 Special Foundation and 5G Program (20224ABC03A05), Wuhan University Specific Fund for Major School-level Internationalization Initiatives (WHU-GJZDZX-PT07).

Healthy lifestyles and rapid progression of carotid plaque in population with atherosclerosis: A prospective cohort study in China.

Background: Healthy lifestyles are effective means to reduce major cardiovascular events. However, little is known about the association of healthy lifestyles with development of carotid atherosclerosis at the early stage of cardiovascular diseases (CVDs). Methods: We enrolled participants from Fujian province in the China PEACE MPP project. We calculated a healthy lifestyle score by adherence to non-smoking, sufficient physical activity, healthy diet and healthy body mass index. Cox proportional hazards regression models and restricted cubic splines (RCS) were used to explore the association between the healthy lifestyles and rapid progression of carotid plaque. Results: 8379 participants were included (mean age: 60.6 ± 8.3 years, 54.6 % female), with a median follow-up of 1.2 years (inter quartile range: 1.0-1.6). RCS showed a significant inverse association between the healthy lifestyle score and progression of carotid plaque. Participants with "intermediate" (HR: 0.72 [95 % confidence interval (CI): 0.65-0.80]) or "ideal" (HR: 0.68 [0.59-0.78]) adherence to healthy lifestyles had a lower risk of progression of carotid plaque compared to those with "poor" adherence. Age, sex, occupation, income, residence type and metabolic status were significant factors influencing the relationship. Farmers benefited more in non-smoking and sufficient physical activity compared to non-farmers, and participants with lower income or without dyslipidaemia benefited more in sufficient physical activity and healthy diet compared to their counterparts (p-for-interaction < 0.05). Conclusions: Healthy lifestyles were associated with lower risk of progression of carotid plaque in populations with atherosclerosis. Promotion of healthy lifestyles from the early stage of carotid atherosclerosis could reduce the burden of CVDs in China.

Rural-urban disparities in the associations of residential greenness with diabetes and prediabetes among adults in southeastern China.

AIMS: Greenness offers health benefits to prevent diabetes in urban areas. However, urban-rural disparities in this association have not been explored, with the underlying pathways understudied as well. We aimed to investigate and compare the associations and potential pathways between residential greenness and the risks for diabetes and prediabetes in urban and rural areas. METHODS: Diabetes and prediabetes were diagnosed by fasting blood glucose (FBG). The participants' residential greenness exposure was estimated by the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). The association of residential greenness with the risks for diabetes and prediabetes was estimated by logistic regression and the generalized additive model. The potential mediation effects of air pollution, body mass index (BMI), and physical activity (PA) were examined by causal mediation analysis. RESULTS: Of the 50,593 included participants, and the prevalence of prediabetes and diabetes were 21.22 % and 5.63 %, respectively. Each 0.1-unit increase in EVI500m and NDVI500m for healthy people reduced the risk for prediabetes by 12 % and 8 %, respectively, and substantially reduced the risk for diabetes by 23 % and 19 %, respectively. For those with prediabetes, each 0.1-unit increase in EVI500m and NDVI500m reduced the diabetes risk by 14 % and 12 %, respectively. Compared to the risks for diabetes at the 25th percentile of EVI500m/NDVI500m, such risks significantly reduced when EVI500m (NDVI500m) increased over 0.43 (0.48) and 0.28 (0.39) in urban and rural areas, respectively. The residential greenness-prediabetes/diabetes associations were mediated by air pollution and PA in urban areas and by air pollution and BMI in rural areas. CONCLUSIONS: Exposure to residential greenness was associated with a lower risk for prediabetes and diabetes in urban areas and, more strongly, in rural areas, which were partly mediated by air pollution, PA, and BMI.

Residential greenness and dyslipidemia risk: Dose-response relations and mediation through BMI and air pollution.

BACKGROUND: Evidence on associations of residential greenness with dyslipidemia is limited, particularly regarding dose-response relations and mediation. OBJECTIVES: To investigate associations between greenness and dyslipidemia, non-linear dose-response relationships and mediators. METHODS: This cross-sectional study draws on the 2018 Fujian Behavior and Disease Surveillance (FBDS) cohort that used multi-stage stratified random sampling from the general population of Fujian Province, China. Participants with one or more abnormities in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C) were classified as having dyslipidemia. Residential greenness was operationalized as 3-year average of the normalized difference vegetation index (NDVI500m) and enhanced vegetation index (EVI500m). A doubly robust approach was used for effect quantification. Dose-response relations were studied with natural cubic splines. Mediation via physical activity (PA), body mass index (BMI), PM2.5, PM10, SO2, and NO2 was also examined. RESULTS: Data from 43,183 participants were analyzed. Increases in NDVI500m and EVI500m residential greenness were associated with decreased dyslipidemia risk and improved blood lipids. Non-linear dose response relationships were discovered. Significant reduction of dyslipidemia risk was observed at levels of EVI500m > 0.48 and NDVI500m > 0.65. Joint mediation effects of PA, BMI, PM2.5, PM10, NO2, and SO2 on the associations of NDVI500m and EVI500m with dyslipidemia risk were 49.74% and 44.64%, respectively. CONCLUSIONS: Increased residential exposure to greenness was associated with decreased risk of dyslipidemia. A non-linear dose-response relationship between greenness and dyslipidemia suggests that specific thresholds of greenness need to be reached in order to achieve effects. BMI, PM2.5, and PM10 partially mediated the association.

Chronic Obstructive Pulmonary Disease Prevalence and Associated Risk Factors in Adults Aged 40 Years and Older in Southeast China: A Cross-Sectional Study During 2019-2020.

Purpose: Chronic obstructive pulmonary disease (COPD) is one of many major public health problems in China, and its prevalence and associated risk factors in the southeast of China need to be determined to facilitate disease control and prevention. Methods: A multistage stratified cluster sampling method was used to select 5486 participants aged ≥ 40 years from nine COPD monitoring districts in Fujian Province during 2019-2020. Participants were interviewed using a laptop-based questionnaire and underwent pulmonary function tests. COPD was diagnosed according to the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Results: Final analysis was conducted using data from 4999 participants with qualified post-bronchodilator results. The prevalence of COPD was 11.6% (95% confidence interval [CI]: 10.5-12.7). Risk factors for COPD in the logistic regression model were being male (odds ratio [OR] = 2.83, 95% CI: 2.01-3.98), > 70 years old (OR = 16.16, 95% CI: 8.14-32.08), having a low body mass index (BMI) (OR = 1.81, 95% CI: 1.13-2.89), parental history of respiratory disease (OR = 1.78, 95% CI: 1.50-2.10), being a current (OR = 2.82, 95% CI: 1.83-4.36) or former (OR = 2.47, 95% CI: 1.45-4.19) smoker, and indoor exposure to biomass (OR = 1.28, 95% CI: 1.05-1.58). Conclusion: The estimated prevalence of COPD in southeast China is high. COPD was strongly associated with sex, aging, a low BMI, parental history of respiratory diseases, smoking, and indoor exposure to biomass in adults aged ≥ 40 years. The government should urgently implement comprehensive measures to reduce the risk factors for COPD.

Eliciting national and subnational sets of disability weights in mainland China: Findings from the Chinese disability weight measurement study.

Background: The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China. Methods: In 2020-2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death). Findings: We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions. Interpretation: The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms. Funding: This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].

Hydrogen sulphide alleviates Fusarium Head Blight in wheat seedlings.

Hydrogen sulphide (H2S), a crucial gas signal molecule, has been reported to be involved in various processes related to development and adversity responses in plants. However, the effects and regulatory mechanism of H2S in controlling Fusarium head blight (FHB) in wheat have not been clarified. In this study, we first reported that H2S released by low concentrations of sodium hydrosulphide (NaHS) could significantly alleviate the FHB symptoms caused by Fusarium graminearum (F. graminearum) in wheat. We also used coleoptile inoculation to investigate the related physiological and molecular mechanism. The results revealed that FHB resistance was strongly enhanced by the H2S released by NaHS, and 0.3 mM was confirmed as the optimal concentration. H2S treatment dramatically reduced the levels of hydrogen peroxide (H2O2) and malondialdehyde (MDA) while enhancing the activities of antioxidant enzymes. Meanwhile, the relative expressions levels of defence-related genes, including PR1.1, PR2, PR3, and PR4, were all dramatically upregulated. Our results also showed that H2S was toxic to F. graminearum by inhibiting mycelial growth and spore germination. Taken together, the findings demonstrated the potential value of H2S in mitigating the adverse effects induced by F. graminearum and advanced the current knowledge regarding the molecular mechanisms in wheat.

Associations and pathways between residential greenness and metabolic syndromes in Fujian Province.

Background: Greenness exposure is beneficial to human health, but its potential mechanisms through which the risk for metabolic syndrome (MetS) could be reduced have been poorly studied. We aimed to estimate the greenness-MetS association in southeast China and investigate the independent and joint mediation effects of physical activity (PA), body mass index (BMI), and air pollutants on the association. Methods: A cross-sectional study was conducted among the 38,288 adults based on the Fujian Behavior and Disease Surveillance (FBDS), established in 2018. MetS was defined as the presence of three or more of the five components: abdominal obesity, elevated triglyceride, reduced high-density lipoprotein cholesterol (HDL-C), high blood pressure, and elevated fasting glucose. The residential greenness exposure was measured as the 3-year mean values of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) within the 250, 500, and 1,000 meters (m) buffer zones around the residential address of each participant. Logistic regression models were used to estimate the greenness-MetS association. The causal mediation analysis was used to estimate the independent and joint mediation effects of PA, BMI, particulate matter with an aerodynamic diameter of 2.5 µm (PM2.5), particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2). Results: Each interquartile range (IQR) increase in greenness was associated with a decrease of 13% (OR = 0.87 [95%CI: 0.83, 0.92] for NDVI500m and OR = 0.87 [95%CI: 0.82, 0.91] for EVI500m) in MetS risk after adjusting for covariates. This association was stronger in those aged < 60 years (e.g., OR = 0.86 [95%CI: 0.81, 0.92] for NDVI500m), males (e.g., OR = 0.73 [95%CI: 0.67, 0.80] for NDVI500m), having an educational level of primary school or above (OR = 0.81 [95%CI: 0.74, 0.89] for NDVI500m), married/cohabitation (OR = 0.86 [95%CI: 0.81, 0.91] for NDVI500m), businessman (OR = 0.82 [95%CI: 0.68, 0.99] for NDVI500m), other laborers (OR = 0.77 [95%CI: 0.68, 0.88] for NDVI500m), and non-smokers (OR = 0.77 [95%CI: 0.70, 0.85] for NDVI500m). The joint effect of all six mediators mediated about 48.1% and 44.6% of the total effect of NDVI500m and EVI500m on the MetS risk, respectively. Among them, BMI showed the strongest independent mediation effect (25.0% for NDVI500m), followed by NO2 and PM10. Conclusion: Exposure to residential greenness was associated with a decreased risk for MetS. PA, BMI, and the four air pollutants jointly interpreted nearly half of the mediation effects on the greenness-MetS association.

Ischemic heart disease deaths, disability-adjusted life years and risk factors in Fujian, China during 1990-2013: Data from the Global Burden of Disease Study 2013.

OBJECTIVES: Ischemic heart disease (IHD) is a large public health problem and is associated with a number of modifiable risk factors. The aim of this study was to estimate the IHD burden and attributable to risk factors in Fujian, China during 1990 to 2013. METHODS: IHD deaths, disability-adjusted life years (DALYs) and attributable to risk factors were estimated as part of the Global Burden of Disease (GBD) 2013 Study. Statistical models were employed to produce comprehensive results of IHD deaths, DALYs and attributable to risk. Means and 95% uncertainty intervals (UIs) were calculated for mortality and DALYs. The median of the percent change and 95% UI were determined for the period between 1990 and 2013. RESULTS: The age-standardized IHD deaths rate increased by 15.3% from 1990 [74.7 (95% UI 62.9-99.1) per 100,000] to 2013 [82.7 (56.5-95.5) per 100,000]. The age-standardized IHD DALYs has slightly decreased 8.8% from 1990 to 2013[from 1356.2 (1134.3-1732.1) to 1202.7 (879.6-1404.6) per 100,000]. All risks combined account for 94.7% (92.9%- 96.0%) of IHD DALYs for all ages in 2013. The five leading risk factors for all ages IHD DALYs were high systolic blood pressure, high total cholesterol, smoking, diet high in sodium, and high fasting plasma glucose. CONCLUSION: Despite decreased age-standardized IHD deaths and DALY rate since 1990, population growth and aging led to a higher global burden of IHD in 2013. Behavioral, environmental, and metabolic risks can explain most of the IHD DALYs providing many opportunities for prevention.

[A comparison study on the life expectancy among residents in Fujian province, 1990-2010].

OBJECTIVE: To analyze the change of life expectancy (LE) among residents of Fujian province over the past two decade and to evaluate the impact of age and causes of death on the differences related to LE. METHODS: Mortality data from Causes of Death Surveillance System of Ministry of Health in Fujian province during 1990-2010 were used to calculate the life expectancy, and Arriaga decomposition method was applied to quantitatively evaluate its changes, based on the age-specific and cause-specific mortality. RESULTS: The LE in urban and rural residents of Fujian province had an increase of 5.82 and 11.67 years during the past two decade, respectively, which were higher in urban residents than in rural residents. Although the increment of LE was higher in rural populations than in urban population, the difference of LE between urban and rural was seen narrowed. The contribution rate of children on LE was reducing and the contribution rate of children below 14 years old to LE in rural resident declined from 78.29% to 31.23%. Middle age and elderly populations had become the major ones that causing the change of LE. The impact of cancer, respiratory diseases and cerebrovascular diseases on LE in urban residents was reducing, while the influence of infectious disease, nervous system disease and cardiac disease was increasing, causing the LE of urban resident increased 1.54,0.67 and 0.49 years, respectively. The impact of respiratory diseases, digestive system diseases, as well as injury and poisoning on LE in the rural residents was reducing, while the effect of cancer, cerebrovascular and cardiac disease increased, causing the LE in the rural resident increased 1.23 years. Different causes of death had different impact on the LE in each age group. CONCLUSION: To reduce the mortality rate in the middle-aged and elderly population and to control the incidence of non-communicable diseases could help to improve the LE in the residents of Fujian province.

[Association between sedentary life style and risks of metabolic syndrome and diabetes mellitus type 2].

OBJECTIVE: To explore the association of sedentary life style with risk of metabolic syndrome (MS) and diabetes mellitus type 2(T2DM). METHODS: A total of 6 016 local residents aged 18 years or older in Fujian province were recruited by multi-stage stratified cluster sampling method in 2010-2011. Data, including demographic information, physical activity and sedentary time were collected. Indices related to height, weight, waist circumference, blood pressure and blood lipid were determined while MS and T2DM were diagnosed by IDF (2005) and WHO (1999) criteria. Logistic regression was used to estimate the correlations between sedentary behavior and MS or T2DM. RESULTS: The prevalence rates of MS and T2DM were 19.0% and 8.0% respectively, in local residents aged 18 years or older, in Fujian province. The overall rate of sedentary behavior was 18.1%, with the mean sedentary time as 4.3 hours. Both data showed significantly differences (P < 0.001) among control group,MS without T2DM group,MS with T2DM group and T2DM without MS group. Compared with the group of sedentary time <2.0 h/d, 1) the group with 2.0-3.5 h/d was significantly correlated with MT group (OR = 1.44, 95% CI:1.03-2.03, P < 0.05), 2) groups of 3.5-6.0 h/d and ≥6.0 h/d were significantly correlated with M, T, MT group, respectively (OR:1.49-1.76 and 1.28-1.58 respectively, 95% CI:1.19-2.45 and 1.02-2.23 respectively, P < 0.05), and 3) sedentary behavior was independently associated with an increased risk of MT group (OR = 1.82, 95% CI: 1.33-2.48, P < 0.01) and M group (OR = 1.43, 95%CI:1.14-1.78, P < 0.01), after the adjustment for factors as age, sex, cigarette smoking, alcohol drinking,BMI, education, occupation, sedentary behavior/sedentary time. CONCLUSION: MS and T2DM were associated with sedentary lifestyle, but these findings should be confirmed through further longitudinal studies.

Serum pepsinogens, gastrin-17 and Helicobacter pylori antibody in the residents of two cities in china with distinct mortality rates of gastric cancer.

Gastric cancer is one of the most common malignant tumors causing death in Fujian Province, China. However, the mortality of gastric cancer is greatly varied in different areas in Fujian; for example, the mortality in Changle City is 7.4 times higher than that in Fuan City. In this study, we compared the differences in serological parameters, pepsinogen (PG) I, PG II, gastrin-17 (G-17), and Helicobacter pylori (H. pylori) antibody, between the two cities. It has been reported that low serum PG I is correlated with atrophic gastritis, a high-risk condition for developing gastric cancer, while high serum G-17 has been used for serological detection of atrophic corpus gastritis. We recruited 224 healthy subjects in Changle and 229 healthy subjects in Fuan, matched in age and sex. The serum levels of PG II and G-17 were significantly higher in Changle than those in Fuan. Importantly, the frequency of the subjects with low serum PG I (< 25 µg/L) was significantly higher in Changle than in Fuan, although the serum PG I levels were similar between the two cities. Moreover, the percentage of the subjects with high serum G-17 (≥ 2 pmol/L) and the positive rate of serum IgG antibody against H. pylori were significantly higher in Changle than those in Fuan. The detected differences in these serological parameters are consistent with the notion that the prevalence of atrophic gastritis may be higher in Changle than in Fuan, which results in a higher risk condition for developing gastric cancer in Changle.