Can global or national disability weights represent provincial level?

BACKGROUND: A universal set of disability weights(DWs) is mainly based on the survey of North America, Australia and Europe, whereas the participants in Asia was limited. The debate hasn't yet settled whether a universal DW is desirable or useful.The focus of the debate is its representativenes-s.After all, the DWs come from people's subjective evaluation of pain, and they may vary according to cultural background.The differences of the DWs could have implications for the magnitude or ranking of disease burdens.The DWs of Anhui Province has not been completely presented.This paper aims to obtain the DWs suitable for the general population of Anhui Province of China, and attempts to explore the differences between different DWs by comparing the DWs with the similar-cultural background and the DWs with cross-cultural background. METHODS: A web-based survey was conducted to estimate the DWs for 206 health states of Anhui province in 2020. Paired comparison (PC) data were analyzed and anchored by probit regression and fitting loess model. We compared the DWs in Anhui with other provinces in China and those in Global burden of disease (GBD) and Japan. RESULTS: Compared with Anhui province, the proportion of health states which showed 2 times or more differences ranged from 1.94% (Henan) to 11.17% (Sichuan) in China and domestic provinces. It was 19.88% in Japan and 21.51% in GBD 2013 respectively. In Asian countries or regions, most of the health states with top 15 DWs belonged to the category of mental, behavioral, and substance use disorders. But in GBD, most were infectious diseases and cancer. The differences of DWs in neighboring provinces were smaller than other geographically distant provinces or countries. CONCLUSION: PC responses were largely consistent across very distinct settings,but the exceptions do need to be faced squarely.The differences of DWs among similar-cultural regions were smaller than cross-cultural regions. There is an urgent need for relevant gold standards.

Establishment of Male and Female Eucommia Fingerprints by UPLC Combined with OPLS-DA Model and Its Application.

Eucommia ulmoides Oliver is a dioecious plant, which plays an important role in traditional Chinese medicine. However, there has not yet been any research on male and female E. ulmoides. The UPLC fingerprints and OPLS-DA approach were able to quickly and easily identify and quantify E. ulmoides and differentiate between the male and female fingerprints. In this study, we optimized the UPLC conditions and analyzed them to investigate fingerprints of twenty-four extracts of Eucommiae Cortex (EC) and twenty-four extracts of Eucommiae Folium (EF) under optimal conditions. It was demonstrated that thirteen and twelve substances were possible chemical markers for EC and EF male and female discrimination and that the level of these markers - chlorogenic acid and protocatechuic acid - was many times higher in male than in female. This approach offered a reference for quality control and precise treatment of male and female E. ulmoides in the clinic.

Spatiotemporal trends and ecological determinants of cardiovascular mortality among 2844 counties in mainland China, 2006-2020: a Bayesian modeling study of national mortality registries.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in China. No previous study has reported CVD mortality at county-level, and little was known about the nonmedical ecological factors of CVD mortality at such small scale in mainland China. Understanding the spatiotemporal variations of CVD mortality and examining its nonmedical ecological factors would be of great importance to tailor local public health policies. METHODS: By using national mortality registration data in China, this study used hierarchical spatiotemporal Bayesian model to demonstrate spatiotemporal distribution of CVD mortality in 2844 counties during 2006 to 2020 and investigate how nonmedical ecological determinants have affected CVD mortality inequities from the spatial perspectives. RESULTS: During 2006-2020, the age-standardized mortality rate (ASMR) of CVD decreased from 284.77 per 100,000 in 2006 to 241.34 per 100,000 in 2020. Among 2844 counties, 1144 (40.22%) were hot spots counties with a higher CVD mortality risk compared to the national average and located mostly in northeast, north central, and westernmost regions; on the contrary, 1551 (54.53%) were cold spots counties and located mostly in south and southeast coastal counties. CVD mortality risk decreased from 2006 to 2020 was larger in counties where CVD mortality rate had been higher in 2006 in most of the counties, vice versa. Nationwide, nighttime light intensity (NTL) was the major influencing factor of CVD mortality, a higher NTL appeared to be negatively associated with a lower CVD mortality, with one unit increase in NTL, and the CVD mortality risk will decrease 11% (relative risk of NTL was estimated as 0.89 with 95% confidence interval of 0.83-0.94). CONCLUSIONS: Substantial between-county discrepancies of CVD mortality distribution were observed during past 15 years in mainland China. Nonmedical ecological determinants were estimated to significantly explain the overall and local spatiotemporal patterns of this CVD mortality risk. Targeted considerations are needed to integrate primary care with clinical care through intensifying further strategies to narrow unequally distribution of CVD mortality at local scale. The approach to county-level analysis with small area models has the potential to provide novel insights into Chinese disease-specific mortality burden.

The burden of pneumoconiosis in China: an analysis from the Global Burden of Disease Study 2019.

BACKGROUND: Pneumoconiosis refers to a class of serious diseases threatening the health of workers exposed to coal or silicosis dust. However, the burden of pneumoconiosis is unavailable in China. METHODS: Incident cases, deaths, and disability-adjusted life years (DALYs) from pneumoconiosis and its subtypes in China were estimated from the Global Burden of Disease Study 2019 using a Bayesian meta-regression method. The trend of the burden from pneumoconiosis was analyzed using percentage change and annualized rate of change (ARC) during the period 1990-2019. The relationship between subnational socio-demographic index (SDI) and the ARC of age-standardised death rate was measured using Spearman's Rank-Order Correlation. RESULTS: In 2019, there were 136.8 (95% uncertainty interval [UI] 113.7-162.5) thousand new cases, 10.2 (8.1-13.6) thousand deaths, and 608.7 (473.6-779.4) thousand DALYs from pneumoconiosis in China. Of the global burdens from pneumoconiosis, more than 60% were in China. Both the total number of new cases and DALYs from pneumoconiosis was keeping increasing from 1990 to 2019. In contrast, the age-standardised incidence, death, and DALY rates from pneumoconiosis and its subtypes, except for the age-standardised incidence rate of silicosis, and age-standardised death rate of asbestosis, experienced a significant decline during the same period. The subnational age-standardised death rates were higher in western China than in eastern China. Meanwhile, the subnational ARC of age-standardised death rates due to pneumoconiosis and its subtypes were significantly negatively correlated with SDI in 2019. CONCLUSION: China suffers the largest health loss from pneumoconiosis in the world. Reducing the burden of pneumoconiosis is still an urgent task in China.

Estimating causes of out-of-hospital deaths in China: application of SmartVA methods.

BACKGROUND: Most deaths in China occur at home, making it difficult to collect reliable cause of death (CoD) information. Verbal autopsy (VA) was applied using the SmartVA tool to a sample of home deaths in China to explore its feasibility as a means of improving the quality of CoD data. METHODS: The study was carried out in 22 districts in 9 provinces, located in north-east, central, and western areas of China during 2017 and 2018. Trained interviewers selected suitable respondents in each household to collect information using the Population Health Metrics Research Consortium (PHMRC) shortened and validated electronic VA questionnaire on tablets. The CoD was diagnosed from the interview data using the SmartVA-Analyze 2.0 software (Tariff 2.0). RESULTS: Non-communicable diseases (NCDs) dominated the leading causes of death in all age groups and for both sexes. After redistribution of undetermined causes, stroke (24%), ischemic heart diseases (IHD) (21%), chronic respiratory diseases (11%), and lung cancer (6%) were the leading causes of death. The cause fractions for level-one cause categories and ranking of specific causes were similar between SmartVA and results from the Global Burden of Disease (GBD) study. CONCLUSION: Evidence from this large pilot study suggests that SmartVA is a feasible and plausible tool and could be a valuable tool to improve the quality and standardization of CoD information across China.

The disease burden attributable to 18 occupational risks in China: an analysis for the global burden of disease study 2017.

BACKGROUND: China has more than 18% of the global population and over 770 million workers. However, the burden of disease attributable to occupational risks is unavailable in China. We aimed to estimate the burden of disease attributable to occupational exposures at provincial levels from 1990 to 2017. METHODS: We estimated the summary exposure values (SEVs), deaths and disability-adjusted life years (DALYs) attributable to occupational risk factors in China from 1990 to 2017, based on Global Burden of Disease Study (GBD) 2017. There were 18 occupational risks, 22 related causes, and 35 risk-outcome pairs included in this study. Meanwhile, we compared age-standardized death rates attributable to occupational risk factors in provinces of China by socio-demographic index (SDI). RESULTS: The SEVs of most occupational risks increased from 1990 to 2017. There were 323,833 (95% UI 283,780 - 369,061) deaths and 14,060,210 (12,022,974 - 16,125,763) DALYs attributable to total occupational risks in China, which were 27.9 and 22.1% of corresponding global levels, respectively. For attributable deaths, major risks came from occupational particulate matter, gases, and fumes (PGFs), and for the attributable DALYs, from occupational injuries. The attributable burden was higher in males than in females. Compared with high SDI provinces, low SDI provinces, especially Western China, had higher death rates attributable to total occupational risks, occupational PGFs, and occupational injuries. CONCLUSION: Occupational risks contribute to a huge disease burden in China. The attributable burden is higher in males, and in less developed provinces of Western China, reflecting differences in risk exposure, socioeconomic conditions, and type of jobs. Our study highlights the need for further research and focused policy interventions on the health of workers especially for less developed provinces in China to reduce occupational health losses effectively.

Associations Between Ambient Nitrogen Dioxide and Daily Cause-specific Mortality: Evidence from 272 Chinese Cities.

BACKGROUND: There has been a long history of debate regarding whether ambient nitrogen dioxide (NO2) directly affects human health. METHODS: We conducted a nationwide time-series analysis in 272 major Chinese cities (2013-2015) to evaluate the associations between short-term exposure to NO2 and cause-specific mortality. We used the overdispersed generalized linear model together with the Bayesian hierarchical model to estimate the associations between NO2 and mortality at the national and regional levels. We examined two-pollutant models with adjustment of fine particles, sulfur dioxide, carbon monoxide, and ozone to evaluate robustness for the effects of NO2. RESULTS: At the national-average level, we observed linear and positive associations between NO2 and mortality from all causes and main cardiorespiratory diseases. A 10 µg/m increase in 2-day average concentrations of NO2 would lead to increments of 0.9% (95% posterial interval [PI], 0.7%, 1.1%) in mortality from total nonaccidental causes, 0.9% (95% PI, 0.7%, 1.2%) from total cardiovascular disease, 1.4% (95% PI, 0.8%, 2.0%) from hypertension, 0.9% (95% PI, 0.6%, 1.2%) from coronary heart disease, 0.9% (95% PI, 0.5%, 1.2%) from stroke, 1.2% (95% PI, 0.9%, 1.5%) from total respiratory diseases, and 1.6% (95% PI, 1.1%, 2.0%) from chronic obstructive pulmonary disease. There were no appreciable differences in estimates from single-pollutant and two-pollutant models. The associations were stronger in the south of China, in the elderly, and in females. CONCLUSIONS: The present study provided robust epidemiologic evidence of associations between day-to-day NO2 and mortality from total natural causes and main cardiorespiratory diseases that might be independent of other criteria air pollutants.

An integrated national mortality surveillance system for death registration and mortality surveillance, China.

In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention's disease surveillance points system and the Ministry of Health's vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China's 31 provinces using an iterative method involving multistage stratification that took into account the sociodemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time.

En Chine, des systèmes de surveillance de la mortalité fondés sur des échantillons (comme le système à points de surveillance des maladies du Centre chinois pour le contrôle et la prévention des maladies et le système d'enregistrement des données d'état civil du ministère de la Santé) sont utilisés depuis plusieurs dizaines d'années pour obtenir des données représentatives à l'échelle nationale de la situation sanitaire, en vue d'éclairer les processus décisionnels en matière de santé et d'évaluer les résultats. Or, aucun de ces systèmes traditionnellement utilisés ne proposait de données représentatives sur la mortalité et les causes de décès à l'échelle provinciale, pourtant nécessaires pour correctement définir les priorités et les besoins régionaux en matière de politiques de santé. Par ailleurs, ces systèmes étaient largement redondants entre eux, ce qui impliquait donc une duplication inutile des efforts. En 2013, le gouvernement chinois a fusionné ces deux systèmes dans un système national intégré de surveillance de la mortalité afin d'obtenir une image représentative à l'échelle provinciale de la mortalité totale et de la mortalité par cause et d'accélérer la création d'un système exhaustif d'enregistrement des données d'état civil et de surveillance de la mortalité pour tout le pays. Ce nouveau système a permis d'augmenter la couverture de la surveillance (de 6% de la population chinoise couverte auparavant à 24%). Le nombre de points de surveillance (chacun couvrant un district ou un comté) est passé de 161 à 605. Pour garantir une bonne représentativité à l'échelle provinciale, les 605 points de surveillance ont été sélectionnés de manière à couvrir les 31 provinces chinoises à l'aide d'une méthode itérative impliquant une stratification à plusieurs degrés qui a tenu compte des caractéristiques sociodémographiques de la population. Cet article décrit l'élaboration et le fonctionnement de ce nouveau système national de surveillance de la mortalité, qui devrait permettre d'obtenir pour la première fois des estimations représentatives à l'échelle provinciale de la mortalité en Chine.

En China, los sistemas de vigilancia de la mortalidad basados en muestras, tales como el sistema de puntos de vigilancia de las enfermedades del Centro de Prevención y Control de Enfermedades de China y el sistema de registro civil del Ministerio de Salud, se han utilizado durante décadas para proporcionar datos nacionalmente representativos del estado de salud para tomar decisiones médicas y evaluaciones de rendimiento. Sin embargo, ningún sistema ofrecía datos representativos en cuanto a defunciones y las causas de las defunciones a un nivel provincial con el objetivo de informar de las necesidades de servicios sanitarios regionales y las prioridades de la política. Asimismo, los sistemas se solapaban hasta un punto considerable, lo que suponía una duplicación de los esfuerzos. En 2013, el gobierno chino combinó estos dos sistemas en un sistema nacional integrado de vigilancia de la mortalidad para proporcionar una imagen provincialmente representativa de la mortalidad total y de la mortalidad por causas específicas y para acelerar el desarrollo de un registro civil completo y un sistema de vigilancia de la mortalidad para todo el país. Este nuevo sistema aumentó la población de vigilancia de un 6 a un 24% de la población china. El número de puntos de vigilancia, donde cada uno cubría un distrito o condado, subió de 161 a 605. Con el objetivo de garantizar una representación a nivel provincial, los 605 puntos de vigilancia se seleccionaron para cubrir las 31 provincias de China mediante la utilización de un método iterativo que consistía en una estratificación de etapas múltiples que tenía en cuenta las características sociodemográficas de la población. Este artículo describe el desarrollo y funcionamiento del nuevo sistema nacional de vigilancia de la mortalidad, el cual se espera que aumente las estimaciones provinciales representativas de mortalidad en China por primera vez.

Propensity score weighting for addressing under-reporting in mortality surveillance: a proof-of-concept study using the nationally representative mortality data in China.

BACKGROUND: National mortality data are obtained routinely by the Disease Surveillance Points system (DSPs) in China and under-reporting is a big challenge in mortality surveillance. METHODS: We carried out an under-reporting field survey in all 161 DSP sites to collect death cases during 2009-2011, using a multi-stage stratified sampling. To identify under-reporting, death data were matched between field survey system and the routine online surveillance system by an automatic computer checking followed by a thorough manual verification. We used a propensity score (PS) weighting method based on a logistic regression to calculate the under-reporting rate in different groups classified by age, gender, urban/rural residency, geographic locations and other mortality related variables. For comparison purposes, we also calculated the under-reporting rate by using capture-mark-recapture (CMR) method. RESULTS: There were no significant differences between the field survey system and routine online surveillance system in terms of age group, causes of death, highest level of diagnosis and diagnostic basis. The overall under-reporting rate in the DSPs was 12.9 % (95%CI 11.2 %, 14.6 %) based on PS. The under-reporting rate was higher in the west (18.8 %, 95%CI 16.5 %, 21.0 %) than the east (10.1 %, 95%CI 8.6 %, 11.3 %) and central regions (11.2 %, 95%CI 9.6 %, 12.7 %). Among all age groups, the under-reporting rate was highest in the 0-5 year group (23.7 %, 95%CI 16.1 %, 35.5 %) and lowest in the 65 years and above group (12.4 %, 95%CI 10.9 %, 13.6 %). The under-reporting rates in each group by PS were similar to the results calculated by the CMR methods. CONCLUSIONS: The mortality data from the DSP system in China needs to be adjusted. Compared to the commonly used CMR method in the estimation of under-reporting rate, the results of propensity score weighting method are similar but more flexible when calculating the under-reporting rates in different groups. Propensity score weighting is suitable to adjust DSP data and can be used to address under-reporting in mortality surveillance in China.

[The disease burden of malignant tumor in China, 1990 and 2010].

OBJECTIVE: To analyze and compare burden of disease caused by malignant tumor in China, 1990 and 2010. METHODS: The indicators including prevalence, death, years of life lost (YLL), years lived with disability (YLD), and disability adjusted of life years (DALY) of malignant tumor from the results of Global Burden of Disease (GBD) 2010 were used to calculate the standardized prevalence rate, mortality rate, YLL rate, YLD rate and DALY rate with the 2010 national census data. The research described the prevalence, death, and burden of disease caused by malignant tumor and analyze the trend of these indicators in 1990 and 2010 in China. RESULTS: In China from 1990 to 2010, the standardized prevalence rate of malignant tumor increased from 529.76/100 000 to 749.57/100 000 (increased by 41.49%); the standardized mortality rate decreased from 196.57/100 000 to 169.88/100 000 (decreased by 13.58%); the standardized DALY rate decreased from 5 206.56/100 000 to 4 150.86/100 000. In 2010, the top five standardized DALY rate of malignant tumor were lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer. Their standardized DALY rate were 892.21/100 000, 787.40/100 000, 521.36/100 000, 303.95/100 000, and 269.94/100 000, respectively. In all kind of malignant tumors, the burden of disease of lung cancer had the fastest-growing rate. The standardized mortality rate of lung cancer increased from 34.78/100 000 in 1990 to 41.09/100 000 in 2010; the standardized DALY rate increased from 830.77/100 000 in 1990 to 892.21/100 000 in 2010. The burden of disease of gastric cancer had the fastest-falling rate. The standardized mortality rate of gastric cancer decreased from 39.65/100 000 in 1990 to 23.79/100 000 in 2010; the standardized DALY rate decreased from 968.96/100 000 in 1990 to 521.36/100 000 in 2010. CONCLUSION: The burden of disease caused by malignant tumor in China remained at high levels in 2010. The top five burden of disease of malignant tumor were lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer. The burden of disease of lung cancer had the fastest-growing rate and gastric cancer had the fastest-falling rate from 1990 to 2010 in China. Prevention and control of malignant tumor was still difficult.

[The disease burden of cardiovascular and circulatory diseases in China, 1990 and 2010].

OBJECTIVE: To analyze the death status of disease burden of cardiovascular and circulatory diseases in 1990 and 2010 in China, and to provide the basic information for cardiovascular and circulatory disease prevention and control. METHODS: Using the results of the Global Burden of Diseases Study 2010 (GBD 2010) to describe the cardiovascular and circulatory diseases deaths status and disease burden in China. The measurement index included the mortality, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). At the same time, we used the population from 2010 national census as standard population to calculate the age-standardized mortality rate and DALY rate, YLL rate and YLD rates which will describe the mortality status and disease burden of total and different types of cardiovascular disease. We also calculated the change in 1990 and 2010 for all indexes, to describe the change of the burden of disease in the 20 years. RESULTS: In 2010, the total deaths of cardiovascular and circulatory diseases reached 3.136 2 million, the mortality rate reached 233.70 per 100 000 people and the age-standardized mortality rate was 256.90 per 100 000 people. The total DALYs, YLLs, and YLDs of cardiovascular and circulatory diseases reached 58.2055, 54.0488, and 4.1568 million person-years, respectively, and the age-standardized DALY rate, YLL rate and YLD rate were 4 639.04, 4 313.13, 325.91 per 100 000. In 1990, the deaths only 2.1675 million and the DALYs, YLLs and YLDs were 45.2679, 42.2922, and 2.9757 million person-years. The age-standardized mortality rate was 300.30 per 100 000 people. And the age-standardized DALY rate, YLL rate and YLD rate were 5 872.58, 5 523.42 and 349.16 per 100 000. Compared with the result in 1990, the total deaths, DALYs, YLLs, and YLDs were increased 44.72%, 28.58%, 27.80%, and 39.68%, respectively, while the age-standardized mortality rate, age-standardized DALY rate, age-standardized YLL rate, and age-standardized YLD rate were decreased 14.45%, 21.01%, 21.91%, and 6.66%, respectively. In 1990 and 2010, cerebrovascular disease caused the most DALYs (24.8768 and 30.1389 million person-years, respectively) compared with other types of cardiovascular and circulatory diseases, and followed by ischemic heart disease (10.1270 and 17.8858 million person-years). And the YLLs of cerebrovascular disease (24.3436 and 29.1726 million person-years) also the highest in different type of cardiovascular and circulatory diseases, ischemic heart disease (8.9919 and 16.0839 million person-years) was the second highest. The deaths of cerebrovascular disease and cerebrovascular disease increased from 1 340.6 and 450.3 thousands in 1990 to 1 726.7 and 948.7 thousands in 2010, respectively. The age-standardized mortality rate and DALY rate of cerebrovascular disease were decreased from 187.19 and 3 335.37 per 100 000 people in 1990 to 141.43 and 2 409.09 per 100 000 people. While in the ischemic heart disease, the age-standardized mortality rate, and DALY rate were increased form 62.53 and 1 318.38 per 100 000 people in 1990 to 77.89 and 1 428.31 per 100 000 people. CONCLUSION: Burden of cardiovascular and circulatory disease became more and more serious in China, of which the cerebrovascular disease and ischemic heart disease were most serious.

[Burden of disease attributable to ambient particulate matter pollution in 1990 and 2010 in China].

OBJECTIVE: To assess the burden of disease attributable to ambient particulate matter pollution in 1990 and 2010 in China. METHODS: On the basis of the results of the Global Burden of Diseases Study 2010 (GBD 2010) for China's estimates, we used population attributable fractions (PAF) to examine the burden of disease (mortality and disability-adjusted life years (DALY)) attributable to ambient particulate matter pollution in 1990 and 2010 in China, with 95% uncertainty interval (95% UI) estimate, and increasing rate to explore the trends of attributed burden of disease across the study period of 20 years. RESULTS: In 2010, 38.9% (95% UI: 27.0%-49.4%) of lower respiratory infections for < 5 years children, 27.2% (95% UI: 10.2%-37.5%) of lung cancer, 29.9% (95% UI: 25.8%-34.2%) of ischemic heart disease, 35.0% (95% UI: 27.4%-41.1%) of stroke, and 21.0% (95% UI: 10.7%-30.3%) of chronic obstructive pulmonary disease (COPD) for ≥ 25 years adults were attributable to ambient particulate matter pollution, which accounted for 1.235 (95% UI: 1.038-1.410) million deaths and 25.230 (95% UI: 21.770-28.600) million person years DALY in total, and increased by 33.4% and 4.0%, respectively by comparison with that in 1990 (0.926 million and 24.260 million person years). Lung cancer accounted for the largest increasing rate of 154.5% (from 0.055 million to 0.140 million) and 130.1% (from 1.330 million person years to 3.060 million person years), followed by ischemic heart disease (118.5%, from 0.130 million to 0.284 million, and 86.6%, from 3.280 million person years to 6.120 million person years) and stroke (41.0%, from 0.429 million to 0.605 million, and 33.8%, from 8.970 million person years to 12.000 million person years). The attributed mortality for both gender mostly occurred in age group of 60-79 years (male: 0.260 million and 0.404 million accounting for 53.7% and 54.8%; female: 0.214 million and 0.236 million accounting for 48.5% and 47.5%) both in 1990 and 2010. The age group of 40-79 years accounted for the most portion of attributed DALY for both gender (male: 8.458 million person years and 13.460 million person years accounting for 62.9% and 83.8%; female: 6.360 million person years and 7.152 million person years accounting for 58.9% and 78.0%). The increasing rates were higher for male than for female. CONCLUSION: The burden of disease attributable to ambient particulate matter pollution was very high in China with significant increase in mortality and disability, which indicates the highly necessity for government to take actions to reduce ambient particulate matter pollution and its health hazards.

[The disease burden of chronic obstructive pulmonary disease among people aged over 15 years in 1990 and 2010 in China].

OBJECTIVE: To analyze the disease burden of chronic obstructive pulmonary disease (COPD) among people aged over 15 years in 1990 and 2010 in China. METHODS: The estimation of China data for the Global Burden of Disease Study 2010 (GBD 2010) was used to analyze the mortality and prevalence as well as the years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted life years (DALY) of COPD in China in 1990 and 2010 for Chinese people aged 15 years and above. The death rate and DALY rate of COPD in China in 1990 and 2010 were compared. RESULTS: In 2010, 0.934 million people (0.534 million men and 0.400 million women) aged over 15 years died from COPD, decreased 34.5% (24.3% for men and 44.4% for women) compared with that in 1990 (1.425 million with 0.705 million men and 0.720 million women). There were 41.764 million COPD patients in 2010 (22.111 million men and 19.653 million women), increased 42.1% (41.7% for men and 42.6% for women) compared with 1990 (29.382 million patients with 15.599 million men and 13.783 million women). The mortality rate of COPD decreased for 61.5% from 2.352/100 000 in 1990 to 90.5/100 000 in 2010. The prevalence rate of COPD was 4.2% and 3.9% in 1990 and 2010, respectively. The DALY, YLL and YLD due to COPD was 16.598, 12.946, and 3.652 million person years, respectively in 2010. The YLD increased 42.3% compared with 1990 (2.567 million person years). From 1990 to 2010, the age-standardized DALY rate, YLL rate and YLD rate decreased from 4 120.1/100 000 to 1 575.9/100 000, from 3 756.9/100 000 to 1 235.6/100 000 and from 363.2/100 000 to 340.3/100 000, respectively. CONCLUSION: Although there was significant decrease of DALY due to COPD in 2010, compared to 1990, the YLD burden is still increasing.

Urban-rural differences in the association between occupational physical activity and mortality in Chinese working population: evidence from a nationwide cohort study.

Background: Despite emerging studies suggesting that occupational physical activity (OPA) might be harmful to health, the available evidence is not definitive. Most of these research studies were conducted in high-income Western countries or in urbanized setting. In China, where over one-third of the population resides in rural area, the impact of OPA on health is not well understood. The goal of this study is to investigate how the association between OPA and mortality vary by urban-rural settings. Methods: Baseline data on OPA was gathered using the Global Physical Activity Questionnaire from 30,650 urban and 49,674 rural working adults as part of the 2013-2014 China Chronic Disease and Risk Factor Surveillance. Participants were followed for a median of 6.2 years, and death records were retrieved from the National Mortality Surveillance System until December 31, 2019. The multivariable Cox proportional hazard model was used to examine urban-rural differences in the association between OPA and all-cause and cardiovascular disease (CVD) mortality. Subgroup analyses were performed by sex, socioeconomic status, leisure time, transportation, and non-occupational physical activity. Findings: During the study period, 1342 deaths were recorded, of which 426 were caused by CVD. In rural area, working adults engaging in occupational moderate-to-vigorous physical activity (MVPA) for ≥40 h per week, compared to those without any, had an adjusted hazard ratio of 0.60 (95% CI: 0.49-0.73) for all-cause mortality and 0.55 (95% CI: 0.37-0.83) for CVD mortality. However, no significant association was found in urban area (0.84 [0.61-1.15] for all-cause mortality, Pinteraction = 0.036; and 0.94 [0.53-1.66] for CVD mortality, Pinteraction = 0.098). The negative associations of occupational MVPA with mortality were more pronounced in women, non-smokers, and those with less non-occupational physical activities. Hypertension, heart rate, and diabetes were important contributors to the relationship between occupational MVPA and mortality. Interpretation: The findings from the current study did not support the notion that high levels of OPA would induce harm. On the contrary, in rural setting, higher levels of OPA were associated with lower mortality risks. Furthermore, the observed urban-rural differences in the association between OPA and mortality underscored the need for context-specific public health guidelines on physical activities. Funding: R&D Program of Beijing Municipal Education Commission (KM202210025026),National Key Research and Development Program of China (2021YFC2500201), and Young Elite Scientist Sponsorship Program by BAST (BYESS2023385).

Epidemiological characteristics of centenarian deaths in China during 2013-2020: A trend and subnational analysis.

BACKGROUND: Studies that comprehensively address the characteristics of centenarian deaths are rare. The present study aimed to examine the characteristics of centenarian deaths in China and their changing trends. METHODS: Data on centenarian deaths between 2013 and 2020 were obtained from the national mortality surveillance system of China, including date, place of death (PoD), and underlying cause of death (CoD). Descriptive analyses were performed to understand the epidemiological characteristics, and a joinpoint regression model was adopted to examine the changing trends in the proportions of different PoDs, CoDs, and centenarian deaths accounting for all deaths and deaths among people aged 65 years and older. RESULTS: There were 46,938 registered centenarian deaths between 2013 and 2020 that included 34,311 females (73.10%) and 12,627 males (26.90%). January (12.05%), February (9.99%), and December (9.74%) were the top three months with the highest number of deaths. The proportions of deaths that occurred in homes, hospitals, and nursing homes were 81.71%, 13.63%, and 2.68%, respectively. The proportion of deaths in nursing homes increased by 9.60% (95% confidence intervals [CIs], 6.4-12.9%) from 2014 to 2020. Heart disease (35.72%) was the leading cause of death, followed by respiratory diseases (17.63%), cerebrovascular disease (15.60%), and old age (11.22%). The proportion of respiratory diseases decreased by 4.8% (95% CI, -8.8 to -0.7%), and the proportion of deaths from old age decreased by 2.3% (95% CI, -4.4 to -0.1%) per year. Shanghai had the highest proportions of deaths in hospitals (39.38%) and nursing homes (14.68%). Sichuan had the highest proportion of deaths attributed to respiratory diseases (32.30%), while Jiangsu (26.58%) and Zhejiang (23.61%) had the highest proportions of deaths from old age. CONCLUSIONS: Unlike other countries, centenarian deaths in China are characterized by a higher proportion of home and heart disease deaths, and this death pattern differs across provinces.

An integrated strategy of spectrum-effect relationship and near-infrared spectroscopy rapid evaluation based on back propagation neural network for quality control of Paeoniae Radix Alba.

The quantitative analysis of near-infrared spectroscopy in traditional Chinese medicine has still deficiencies in the selection of the measured indexes. Then Paeoniae Radix Alba is one of the famous "Eight Flavors of Zhejiang" herbs, however, it lacks the pharmacodynamic support, and cannot reflect the quality of Paeoniae Radix Alba accurately and reasonably. In this study, the spectrum-effect relationship of the anti-inflammatory activity of Paeoniae Radix Alba was established. Then based on the obtained bioactive component groups, the genetic algorithm, back propagation neural network, was combined with near-infrared spectroscopy to establish calibration models for the content of the bioactive components of Paeoniae Radix Alba. Finally, three bioactive components, paeoniflorin, 1,2,3,4,6-O-pentagalloylglucose, and benzoyl paeoniflorin, were successfully obtained. Their near-infrared spectroscopy content models were also established separately, and the validation sets results showed the coefficient of determination (R2 > 0.85), indicating that good calibration statistics were obtained for the prediction of key pharmacodynamic components. As a result, an integrated analytical method of spectrum-effect relationship combined with near-infrared spectroscopy and deep learning algorithm was first proposed to assess and control the quality of traditional Chinese medicine, which is the future development trend for the rapid inspection of traditional Chinese medicine.

Spatial variations and social determinants of life expectancy in China, 2005-2020: A population-based spatial panel modelling study.

Background: Social determinants of health (SDOH) produce a broad range of life expectancy (LE) disparities. In China, limited literatures were found to report association between SDOH and LE at ecological level during a consecutive period of time from the spatial perspectives. This study aimed to determine the existence, quantify the magnitude, and interpret the association between SDOH and LE in China. Methods: Provincial-level LE were estimated from mortality records during 2005-2020 from National Mortality Surveillance System in China. A spatial panel Durbin model was used to investigate LE associated SDOH proxies. Spatial spillover effects were introduced to interpret direct and indirect effects caused by SDOH during long-term and short-term period on LE disparities. Findings: Nationwide, LE increased from 73.1 (95% confidence interval (CI): 71.3, 74.4) years to 77.7 (95%CI: 76.5, 78.7) years from 2005 to 2020. Unequally spatial distribution of LE with High-High clustering in coastal areas and Low-Low clustering in western regions were observed. Locally, it was estimated that SDOH proxies statistically significant related to an increase of LE, including GDP (coefficient: 0.02, 95%CI: 0.00, 0.03), Gini index (coefficient: 2.35, 95%CI: 1.82, 2.88), number of beds in health care institutions (coefficient: 0.02, 95%CI: 0.00, 0.05) and natural growth rate of resident population (coefficient: 0.02, 95%CI: 0.01, 0.02). Direct and indirect effects decomposition during long-term and short-term of LE associated SDOH proxies demonstrated that GDP, urbanization rate, unemployment rate, education attainment, Gini index, number of beds in health care institutions, sex ratio, gross dependence ratio and natural growth rate of resident population not only affected local LE, but also exerted spatial spillover effects towards geographical neighbors. Interpretation: Spatial variations of LE existed at provincial-level in China. SDOH regarding socioeconomic development and equity, healthcare resources, as well as population characteristics not only affected LE disparities at local scale but also among nearby provinces. Externalities of policy of those SDOH proxies should be took into consideration to promote health equity nationally. Comprehensive approaches on the basis of population strategy should be consolidated to optimize supportive socioeconomic environment and narrow the regional gap to reduce health disparities and increase LE. Funding: National Key Research & Development Program of China (Grant No.2018YFC1315301); Ministry of Education of China Humanities and Social Science General Program (Grant No.18YJC790138).

Trends and associated factors in place of death among individuals with cardiovascular disease in China, 2008-2020: A population-based study.

Background: Cardiovascular disease (CVD) is the leading cause of death (COD) in China. Understanding the characteristics of place of death (POD) among CVD deaths would be of great importance to evaluate the healthcare service utilization at the end stage of life. Limited studies have reported the POD distribution among CVD deaths, and little was known about the associated factors of hospital CVD deaths. Methods: By using data from National Mortality Surveillance System (NMSS) in China, this study presented the characteristics of POD distribution during 2008 and 2020. Afterwards, multilevel logistic regression was used to explore associated factors of hospital CVD deaths and quantify the magnitude to which the spatial variations of hospital CVD deaths could be explained by those associated factors. Findings: During 2008-2020, there was 7101871 CVD deaths collected by NMSS in China, with 77·13% home deaths and 18·49% hospital deaths. Shanghai (59·40%) had the highest percentage of hospital CVD deaths. Age, sex, ethnicity, marital status, education, occupation, underlying COD were significant influential factors of hospital CVD deaths. Spatial variations were shown at provincial level, with 33·88% of them being explained by factors at individual level. Interpretation: Home was the leading POD among CVD deaths in China, those CVD decedents characterized as the female, the youngest, Han population, the married, the retiree, lived in urban areas, with higher socioeconomic status and died of chronic CVDs had a higher probability of hospital deaths. Providing accessible and available healthcare services were priorities to improve quality of end-of-life care, significant variations among provinces and sub-population also reminded us of the requirements for equal healthcare resources allocation and multiple options for minorities of POD preference at the end stage of life. Funding: National Key Research & Development Program of China (grant number 2018YFC1315301).

National Cancer Data Linkage Platform of China: Design, Methods, and Application.

Background: The National Cancer Center (NCC) and China CDC cooperatively designed a National Cancer Data Linkage (NCDL) Platform to fulfill the task of sharing cancer outcome data through an automatic web-based system. Methods: NCC and China CDC established a web-based NCDL Platform to link death information from China CDC with the cancer database from NCC. Overall, 76,708 cancer patients' data were analyzed to assess the feasibility and match rate of the NCDL Platform for 7 major cancers. Results: The function of the platform includes a data application and approval system, data linkage module, and results visualization system. Through the platform, 38.9% cases were identified as deaths cases from the NCDL Platform in the first 3 years after cancer diagnosis. The linkage rate was highest in liver cancer and lowest in breast cancer. Conclusions: The NCDL Platform provides a powerful and efficient way to link national vital statistics with national cancer programs' data. Expanding cancer outcome data linkage may not only improve data collection efficiency, but also improve data use.

Mortality and years of life lost of cardiovascular diseases in China, 2005-2020: Empirical evidence from national mortality surveillance system.

OBJECTIVES: Cardiovascular disease (CVD) is leading cause of death in China. We aimed to provide national and subnational estimates and its change of premature mortality burden of CVD during 2005-2020. METHODS: Data from multi-source on the basis of national mortality surveillance system (NMSS) was used to estimate mortality and years of life lost (YLL) of total CVD and its subcategories in Chinese population across 31 provinces during 2005-2020. RESULTS: Estimated CVD deaths increased from 3.09 million in 2005 to 4.58 million in 2020; the age-standardized mortality rate (ASMR) decreased from 286.85 per 100,000 in 2005 to 245.39 per 100,000 in 2020. A substantial reduction of 19.27% of CVD premature mortality burden, as measured by age-standardized YLL rate, was observed. Ischemic heart disease (IHD), hemorrhagic stroke (HS) and ischemic stroke (IS) were leading 3 causes of CVD death. Marked differences were observed in geographical patterns for total CVD and its subcategories, and it appeared to be lower in areas with higher economic development. Population ageing was dominant driver contributed to CVD deaths increase, followed by population growth. And, age-specific mortality shifts contributed largely to CVD deaths decline in most provinces. CONCLUSION: Substantial discrepancies were demonstrated in CVD premature mortality burden across China. Targeted considerations were needed to integrate primary care with clinical care through intensifying further strategies for reducing CVD mortality among specific subcategories, high risk population and regions with inadequate healthcare resources.