The association between education and premature mortality in the Chinese population: a 10-year cohort study.

Background: Recent studies have shown significant associations between education and premature mortality. However, the relationship differs across countries. We aimed to present the latest evidence on the educational inequalities in premature mortality in the Chinese population. Methods: We linked two databases, to establish a population-based, ten-year cohort spanning 2010 to 2020. Cox proportional hazard regression analyses adjusting for age, sex and urbanicity were conducted for all-cause mortality, and competing risk models were fitted for cause-specific mortality. We calculated population attributable fraction (PAF) using the hazard ratios (HRs) obtained by regression analyses. Additionally, we fitted models adjusting for risk factors and investigated the mediating effect of income, smoking, alcohol consumption and diets. Findings: Compared with individuals with upper secondary and above education, the HR for premature all-cause mortality for those with less than primary education was 1.93 (95% CI: 1.72-2.19). The HRs were the highest for deaths from respiratory diseases (HR = 3.09, 95% CI 1.82-5.27). The excess risk of premature mortality associated with low education was higher among women and urban population. The association of education remained significant after accounting for risk factors, and income was the main mediator, which accounted for 23.0% of mediation in men and 11.1% in women. Interpretation: The study's findings support the increased risk of premature mortality associated with low education, particularly in women and urban populations. The considerable number of deaths attributed to educational inequality underscores the necessity for more effective and targeted public health interventions. Funding: Chinese Central Government.

Trends in insufficient physical activity among adults in China 2010-18: a population-based study.

BACKGROUND: The global prevalence of insufficient physical activity (PA) was reported to be 27.5% in 2016, and there were stable levels of insufficient PA worldwide between 2001 and 2016. The global target of a 10% reduction in insufficient PA by 2025 will not be met if the trends remain. The relevant data for trends in China were still scarce. This study aimed to determine nationwide temporal trends in insufficient PA among adults in China from 2010 to 2018. METHODS: 645 903 adults aged 18 years or older were randomly selected from four nationally representative cross-sectional surveys of the China Chronic Disease and Risk Factor Surveillance conducted in 2010, 2013, 2015, and 2018. PA was measured using the Global Physical Activity Questionnaire. Temporal changes in insufficient PA prevalence and participation of domain-specific moderate- to vigorous-intensity PA (MVPA) were analyzed using logistic regression. RESULTS: From 2010 to 2018, the age-adjusted prevalence of insufficient PA in China increased from 17.9% (95% confidence interval 16.3% to 19.5%) in 2010 to 22.3% (20.9% to 23.8%) in 2018 (P for trend < 0.001). By age group, with a significant increase in insufficient PA in adults aged 18-34 years (P for trend < 0.001), which rose more rapidly than in adults aged ≥ 35 years (P for interaction < 0.001). Insufficient PA has increased significantly among adults engaged in agriculture-related work, non-manual work, and other manual work (all P for trend < 0.05). And among the occupational groups, those engaged in agriculture-related work had the fastest increase (P for interaction = 0.01). The percentage of adults participating in work-related MVPA decreased from 79.6% (77.8% to 81.5%) to 66.8% (64.9% to 68.7%) along with a decrease in time spent on work-related MVPA, while percentages of adults participating in recreation-related MVPA increased from 14.2% (12.5% to 15.9%) to 17.2% (16.0% to 18.4%) (all P for trend < 0.05). CONCLUSIONS: Among Chinese adults, an increasing trend was found in insufficient PA from 2010 to 2018, with more than one-fifth of adults failing to achieve the recommendation of adequate PA. More targeted PA promotion strategies should be developed to improve population health.

Breast Cancer Screening Coverage - China, 2018-2019.

What is already known about this topic?: In 2015, only 18.9% of adult women underwent breast cancer screening in China. What is added by this report?: Breast cancer screening coverage for women aged 20 years and above in China reached 22.3% during 2018-2019. Women with lower socioeconomic status had lower screening coverage. There were significant variations across the provincial-level administrative divisions. What are the implications for public health practice?: The promotion of breast cancer screening requires the maintenance of national and local policies, as well as financial support for screening services. In addition, there is a need for the strengthening of health education and the improvement of accessibility to health services.

Prevalence of Chronic Kidney Disease in China: Results From the Sixth China Chronic Disease and Risk Factor Surveillance.

Importance: To our knowledge, there has been no update on the prevalence of chronic kidney disease (CKD) in China since 2012. Objective: To provide periodic nationwide data on the prevalence of CKD and the associated behavioral and metabolic risk factors in China. Design, Setting, and Participants: This nationally representative cross-sectional study included data from 176 874 adults from all 31 provincial-level administrative divisions in mainland China, as reported in the sixth China Chronic Disease and Risk Factor Surveillance conducted from August 2018 to June 2019. Data analysis was performed in 2021 to 2022. Exposures: Serum creatinine, urinal creatinine, and urine albumin were measured for all participants. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI equation. Main Outcomes and Measures: The primary outcome was weighted prevalence of CKD in the overall population and different strata, defined as presence of impaired kidney function (eGFR of <60 mL/min/1.73m2) or albuminuria (urine albumin-to-creatinine ratio of ≥30 mg/g). Secondary outcomes were awareness of CKD and control of comorbidities. Logistic regression was used to examine the association of sociodemographic characteristics, behavioral and dietary habits, physical activity, and comorbidities with CKD. Results: A total of 184 876 participants contributed data to this study, and of the 176 874 adults 18 years and older with measurements of eGFR and urine albumin-to-creatinine ratio in 2018 to 2019, the mean age was 43.8 years and the weighted proportion of women was 44.6%. The estimated prevalence of CKD, impaired kidney function, and albuminuria were 8.2%, 2.2%, and 6.7%, respectively. A higher prevalence of CKD was observed in the subgroups characterized by older age, female gender, non-Han ethnicity, residency of rural or north and central parts of China, receiving less education or lower income, former smoking, no alcohol drinking, lacking physical activity, and presence of risk factors such as obesity, hypertension, diabetes, dyslipidemia, and self-reported cardiovascular disease. Among the adults with CKD, 73.3%, 25.0%, and 1.8% were at stage 1 to 2, 3, and 4 to 5, respectively, and the awareness of CKD was 10.0%. Conclusions and Relevance: This cross-sectional study found a weighted estimated of 82 million adults with CKD in China in 2018 to 2019. The prevalence appears to have decreased by 30% in the past decade. Better environmental protection, integration of CKD into the national public health surveillance program, and control of common CKD comorbidities appear to be associated with reducing the disease burden of CKD.

Trends in smoking prevalence in urban and rural China, 2007 to 2018: Findings from 5 consecutive nationally representative cross-sectional surveys.

BACKGROUND: Tobacco smoking is a leading cause of premature death in China, especially among adult men. Since the implementation of the Framework Convention on Tobacco Control in 2005, nationwide tobacco control has been strengthened, but its long-term impact on smoking prevalence is unclear. METHODS AND FINDINGS: Five nationally representative surveys of the China Chronic Disease and Risk Factor Surveillance (CCDRFS) were conducted in 2007, 2010, 2013, 2015, and 2018. A total of 624,568 adults (278,605 men and 345,963 women) aged 18 to 69 years were randomly selected from 31 provinces (or equivalent) in China. Temporal changes in smoking prevalence and patterns (e.g., percentages of those smoking manufactured cigarettes, amount smoked, and age at smoking initiation) were analyzed, overall and by sex, urban or rural residence, year of birth, education and occupation, using linear regression methods. Among men, the standardized prevalence of current smoking decreased from 58.4% (95% confidence interval [CI]: 56.1 to 60.7) to 50.8% (95% CI: 49.1 to 52.5, p < 0.001) between 2007 and 2018, with annual decrease more pronounced in urban (55.7% [95% CI: 51.2 to 60.3] to 46.3% [95% CI: 43.7 to 49.0], p < 0.001) than rural men (59.9% [95% CI: 57.5 to 62.4] to 54.6% [95% CI: 52.6 to 56.6], p = 0.05) and in those born before than after 1980. Among rural men born after 1990, however, the prevalence increased from 40.2% [95% CI: 34.0 to 46.4] to 52.1% ([95% CI: 45.7 to 58.5], p = 0.007), with the increase taking place mainly before 2015. Among women, smoking prevalence remained extremely low at around 2% during 2007 to 2018. No significant changes of current smoking prevalence (53.9% to 50.8%, p = 0.22) were observed in male patients with at least 1 of major chronic diseases (e.g., hypertension, diabetes, myocardial infarction, stroke, chronic obstructive pulmonary disease (COPD)). In 2018, 25.6% of adults aged ≥18 years smoked, translating into an estimated 282 million smokers (271 million men and 11 million women) in China. Across 31 provinces, smoking prevalence varied greatly. The 3 provinces (Yunnan, Guizhou, and Hunan) with highest per capita tobacco production had highest smoking prevalence in men (68.0%, 63.4%, and 61.5%, respectively), while lowest prevalence was observed in Shanghai (34.8%). Since the children and teenage groups were not included in the surveys, we could not assess the smoking trends among youths. Furthermore, since the smoking behavior was self-reported, the smoking prevalence could be underestimated due to reporting bias. CONCLUSIONS: In this study, we observed that the smoking prevalence has decreased steadily in recent decades in China, but there were diverging trends between urban and rural areas, especially among men born after 1980. Future tobacco control strategies should target rural young men, regions with high tobacco production, and patients suffering from chronic diseases.

Cervical Cancer Screening Coverage - China, 2018-2019.

What is already known about this topic?: The World Health Organization set a 2030 target of 70% cervical cancer screening coverage for women aged 35-45 years. Coverage stood at 37% in China in 2015. What is added by this report?: In 2018-2019, China's cervical cancer screening coverage reached 43.4% in women aged 35-44 years and 36.8% in women aged 35-64 years. Screening coverage was still lower in rural areas as well as central and western regions; large variations existed across provincial-level administrative divisions. What are the implications for public health practice?: National and local policy and financial support should be maintained for cervical cancer screening, along with more targeted health education and outreach efforts and strengthened accessibility of health services in the rural areas and central and western regions.

Breast Cancer Screening Rates Among Women Aged 20 Years and Above - China, 2015.

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Breast cancer is the most common cancer in women in China and around the world. By 2019, 121 countries have instituted a national screening program as a secondary prevention measure for breast cancer. WHAT IS ADDED BY THIS REPORT?: Breast cancer screening rates in China were 18.9% in women aged 20 years and above, and 25.7% in women aged 35-64 years in 2015. The screening rate for women aged 20 years and above was significantly higher in urban areas than in rural areas (24.6% vs. 15.0%), and in the eastern region than in the central and western regions (24.0% vs. 15.1% and 15.3%). WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: Continued efforts should be made to strengthen national and local policy initiatives and financial support for population-based, organized screening programs for breast cancer. Health education and accessibility of screening services to women across the country should be strengthened, especially for women aged 50 years and above.

E-cigarette use among adults in China: findings from repeated cross-sectional surveys in 2015-16 and 2018-19.

BACKGROUND: The use of e-cigarettes among adults is increasing globally. Since 2018, policies in China have restricted e-cigarette use; however, little information is available on the national trend in e-cigarette use before regulations were implemented. Therefore, we sought to estimate the trend in e-cigarette use in China before policy implementation and explored associated factors. METHODS: We assessed two nationally representative cross-sectional datasets from the China Chronic Disease and Nutrition Surveillance (CCDNS) surveys initiated in 2015 (June, 2015, to May, 2016) and 2018 (August, 2018, to June, 2019). The surveys were done at 298 national disease surveillance points in 31 provinces in mainland China, and used a multistage, stratified, cluster-randomised sampling design, recruiting community-based Chinese adults aged 18 years and older. Within the standard CCDNS survey, face-to-face questionnaire interviews were used to collect self-report data on e-cigarette use in the preceding 30 days. E-cigarette users were those who self-reported e-cigarette use on 1 day or more in the past 30 days. Prevalence estimates of past 30-day e-cigarette use were weighted to represent the Chinese adult population accounting for the complex sampling design. Populations for the years 2015-16 and 2018-19 were standardised with the 2010 population census to gain comparable estimates. Multivariable logistic regression models adjusted for age, sex, urban or rural residence, household income, occupation, and education level were applied to identify factors associated with the likelihood of e-cigarette use among the total population, ever smokers (current and former), and never smokers across both surveys. FINDINGS: Our study included 189 306 Chinese adults from the 2015 survey (100 405 [53·0%] women; mean age 43·6 years [SD 14·6]) and 184 475 Chinese adults from the 2018 survey (102 373 [55·5%] women; mean age 43·4 years [13·9]). The weighted prevalence of past 30-day e-cigarette use among Chinese adults increased from 1·3% (95% CI 1·1-1·5%) in 2015-16 to 1·6% (95% CI 1·4-1·8%) in 2018-19 (an increase of 0·3% [95% CI 0·1-0·6]; Rao-Scott χ2 p=0·0086). Based on weighted proportion data, e-cigarette users were predominantly men (97·4% [95% CI 96·7-98·1] in 2015-16 and 97·0% [95·4-98·6] in 2018-19) and current conventional smokers (93·0% [90·7-95·2] in 2015-16 and 96·2% [95·1-97·3] in 2018-19). Across both surveys, the odds of e-cigarette use were significantly associated with obesity (odds ratio 1·6 [95% CI 1·3-2·1]; p=0·0007), awareness of smoking hazards (1·2 [1·0-1·4]; p=0·022), and smoking status (in current smokers, 135·2 [87·7-208·6]; and in former smokers, 33·5 [21·3-52·7]; p<0·0001). Among current smokers, the odds were increased with daily cigarette consumption (2·1 [1·5-2·8]; p<0·0001), smoking more than 20 cigarettes per day (1·8 [1·5-2·3]; p<0·0001), and an attempt to quit smoking (within the past 12 months, 1·9 [1·5-2·4]; and before the past 12 months, 1·5 [1·3-1·9]; p<0·0001). In never smokers, the odds were increased in those aware of the hazards of smoking (2·4 [1·2-4·7]; p=0·011). INTERPRETATION: E-cigarette use in China remains low but has increased substantially between 2015 and 2019. Our study identified increased e-cigarette use among subpopulations, and use patterns, that warrant further attention from public health policy makers in China. FUNDING: Chinese Central Government, National Key Research and Development Program of China.

A nationally quasi-experimental study to assess the impact of partial organized breast and cervical cancer screening programme on participation and inequalities.

BACKGROUND: Organized breast and cervical cancer screening programme could only provide services at no cost for a fraction of socioeconomic-deprived women in China and other low-resource countries, however, little evidence exists for whether such a programme effectively affect the participation and inequalities at the population level. METHODS: We used individual-level data from a nationally cross-sectional survey in 2014-2015 for breast and cervical cancer screening participation. Data for intervention and comparison grouping were from 2009 to 2014 national breast and cervical cancer screening programme, and counties covered by the programme were divided into intervention group. We assessed the impact of the intervention on the participation rates and the magnitude of inequalities with two approaches: multivariable multilevel logistic regressions adjusting for individual- and region-level covariates; and a difference analysis combined with propensity score matching that estimated the average intervention effect. RESULTS: Of 69,875 included women aged 35-64 years, 21,620 were classified into the intervention group and 43,669 into the comparison group for breast cancer screening; and 31,794 into the intervention group, and 33,682 into the comparison group for cervical cancer screening. Participation rate was higher in intervention group than comparison group for breast cancer screening (25.3, 95% confidential interval [CI], 22.8-27.7%, vs 19.1, 17.4-20.7%), and cervical cancer screening (25.7, 23.8-27.7%, vs 21.5, 19.6-23.5%), respectively. Intervention significantly increased the likelihood of participation for both breast cancer and cervical cancer screening in overall women, rural women and urban women, whereas the effect was significantly higher in rural women than urban women. The average intervention effect on the participation rate was an increase of 7.5% (6.7-8.2%) for breast cancer screening, and 6.8% (6.1-7.5%) for cervical cancer screening, respectively. The inequalities were significantly decreased by 37-41% (P < 0.001) between rural and urban, however, were slightly decreased or even increased in terms of age, education status, and household income. CONCLUSIONS: Organized breast and cervical cancer screening programme targeting for a fraction of women could increase the participation rates at population level, however, it could not significantly affect socioeconomic-introduced inequalities. Further studies are need to conduct time-series analyses and strengthen the causal correlation.

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.

Cervical Cancer Screening Rates Among Chinese Women - China, 2015.

What is already known about this topic? Cervical cancer is the fourth most common cancer of women around the world. Age-adjusted incidence and mortality rates of cervical cancer were 11.78 and 3.29 per 100,000, respectively, in China in 2015. What is added by this report? Cervical cancer screening rates were 25.7% for women aged 20-64 years old and 31.4% for women aged 35-64 years old in China in 2015. Screening rates were lower in rural areas than in urban areas and varied across provinces. What are the implications for public health practice? Efforts should be made to continue to strengthen national and local policy initiatives, financial support, health education, and accessibility to women in rural areas for cervical cancer screening coverage.

Geographical variations in cardiovascular health in China: A nationwide population-based survey of 74,726 adults.

BACKGROUND: Cardiovascular disease is the leading cause of death in China. The aim of this study was to evaluate the levels of cardiovascular health among Chinese adults and to understand the geographic pattern of cardiovascular health. METHODS: In 2015, a total of 74,726 respondents aged ≥ 20 years with no history of cardiovascular disease were randomly sampled from 298 counties/districts of 31 provinces in mainland China and were interviewed. Seven metrics, including smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting glucose, were determined. Ideal cardiovascular health was defined as the simultaneous presence of all metrics at the ideal level. A score ranging from 0 to 14 was calculated as the sum of all seven metrics for each province. Scores for cardiovascular health behaviors (smoking, body mass index, physical activity and diet) and those for cardiovascular health factors (smoking, total cholesterol, blood pressure, and fasting glucose) were also calculated. FINDINGS: The mean age was 44.4 ± 15.9 years, and 49.3% were women. The age-sex-standardized prevalence of ideal cardiovascular health was universally poor, ranging from 0.02% [95% confidence interval (CI): 0%, 0.05%] in Tibet to 2.76% (95% CI: 0.45%, 5.07%) in Heilongjiang. Ideal diet (7.1%) was the least common factor of the seven metrics in each province and varied considerably across provinces. Other component metrics of ideal cardiovascular health were also spatially patterned. In all provinces, women had higher scores than men for cardiovascular health, health behaviors and health factors. Differences in cardiovascular health and health behavior scores between urban and rural areas were associated with levels of socio-economic development. INTERPRETATION: Strategies for addressing poor cardiovascular health require geographic targeting and localized consideration. FUNDING: This research was supported by National Key R&D Program, the Shenzhen Strategic Emerging Industry Development Special Fund, and the Fund of "Sanming" Project of Medicine in Shenzhen.

Disease and disparity in China: a view from stroke and MI disease.

BACKGROUND: The actual distribution of stroke and myocardial infarction (MI) associated with social economic status (SES) among the Chinese population is unclear. We aim to understand the development of disparity in stroke and myocardial infarction (MI) across different income groups in Chinese population. METHODS: Data about stroke and MI disease, income, gender, and areas were obtained from China Chronic Disease and Risk Factor (CCDRF) Survey in 2007, 2010, and 2013. Respondents were categorized into different income groups according to their income rank, disease rate was calculated in each group, and difference in disparities between genders, health behaviors, and areas were further identified. Association of disease prevalence rate and income was verified by logistic regression. Trends in stroke and MI disease prevalence rate across income gradients; trends in the correlation between stroke and MI disease prevalence rate and income over time; variation in stroke and MI disease levels and its disparity across income groups by gender, region, and health behavior. Disease prevalence rate is age-adjusted by using China census 2010 population structure as a standard. RESULTS: Three waves of survey were included, the sample size in each wave was 45,095 (year 2007), 84,117 (year 2010), and 134,962 (year 2013). Four major findings were delivered. First, the stroke and MI prevalence rate of Chinese population increased from 2007 to 2013. Second, for each survey wave, a negative correlation between stroke and MI risk with income was identified, and this correlation became weaker over time. The gap in stroke and MI prevalence rate between the richest people and the poorest people decreased from 2007 (gap = 2.5 percentage points) to 2013 (gap = 1.6 percentage points). Third, the identified health inequality varied across genders, regions, and health behaviors. For example, female population used to face a sharper decline in prevalence rate when income grew, this correlation, however, faded over time. The rural-urban difference in disease risk was found to be the largest in the bottom income group (in 2013, the prevalence rate in urban area was 5%, which was 1.8% higher than rural places), this rural-urban difference converged as income increased. Fourth, conditioning on the smoking behavior, the negative association of income and stroke and MI prevalence rate was identified, however, conditioning on the drinking behavior, the association of income and disease morbidity was inconclusive. CONCLUSION: During 2007 and 2013, the Chinese residents experienced a growth in stroke and MI prevalence rate, meanwhile, the increase in income was associated with a decrease in prevalence rate. However, this health disparity became weaker over time since the prevalence rate was more equally distributed across income gradients as time passed by. Although male population faced a systematically higher stroke and MI disease risk than female, the prevalence disparity in different income groups were similar in both sexes in 2013. In addition, there were also regional differences in inequality in terms of the association of disease and income.

Prevalence of Smoking and Knowledge About the Hazards of Smoking Among 170 000 Chinese Adults, 2013-2014.

INTRODUCTION: Periodic population surveys of smoking behavior can inform development of effective tobacco control strategies. We investigated smoking patterns, cessation, and knowledge about smoking hazards in China. METHODS: A nationally representative cross-sectional survey recruited 176 318 people aged ≥18 years across 31 provinces of China in 2013-2014, using multi-stage stratified cluster sampling methods. The smoking patterns, cessation, and knowledge about smoking hazards were analyzed, overall and in population subgroups, adjusting for sample selection weight and post-stratification factors. RESULTS: Among men, 60.7% were ever-smokers, with proportions of regular, occasional and former smokers being 46.3%, 5.5%, and 8.8% respectively. Among women, only 2.8% had ever smoked. The prevalence of ever smoking in men was higher in rural than urban areas (63.2% vs. 57.6%) and varied from 39.5% to 67.4% across 31 provinces. Among male regular smokers, the mean daily number of cigarettes smoked was 17.8, with mean age at first starting to smoke daily being 20.1 years. Among current smokers, one-third (32.6% men, 32.1% women) had tried to quit before and 36.8% (36.8% men, 35.5% women) intended to quit in the future. Of the Chinese adults, 75.9% recognized that smoking was hazardous, with the proportions believing that smoking could cause lung cancer, heart attack or stroke being 67.0%, 33.2%, and 29.5%, respectively and with 26.0% reporting that smoking could cause all these conditions. CONCLUSION: Among Chinese adults, the smoking prevalence remained high in men but was low in women. In both men and women, knowledge about smoking hazards was poor. IMPLICATIONS: This study showed that tobacco smoking remained highly prevalent among adult men in China in 2013-2014. Moreover, men born in recent decades were more likely to start smoking at younger ages and to smoke more cigarettes than those born in previous generations. There was a large regional variation in male smoking prevalence, with the least economically developed regions having higher prevalence. In contrast, few women in China smoked, especially among those born in recent decades. The contrasting smoking patterns in men and women is likely to result in an increasingly large gender disparity in life expectancy in the coming decades.

Significant variations in the cervical cancer screening rate in China by individual-level and geographical measures of socioeconomic status: a multilevel model analysis of a nationally representative survey dataset.

Variations in cervical cancer screening rates in China have rarely been studied in depth. This study aimed to investigate cervical cancer screening rates in relation to both individual-level and geographical measures of socioeconomic status (SES). Data were obtained from women aged 21 years or older by face-to-face interviews between August 2013 and July 2014 as part of the Chinese Chronic Diseases and Risk Factors Surveillance. The geographical variables were obtained from the 2010 Chinese population census. The cervical cancer screening rates and 95% confidence interval (CI) were estimated and mapped. Multilevel logistic regression models were fitted. Overall, only 21.4% (95% CI: 19.6-23.1%) of 91,816 women aged ≥21 years reported having ever been screened for cervical cancer and significant geographical variations at both province and county levels were identified (P < 0.01). The cervical cancer screening rates were the lowest among the poor [13.9% (95% CI: 12.1-15.7%)], uninsured [14.4% (95% CI: 10.3-18.4%)], less-educated [16.0% (95% CI: 14.3-17.6%)], and agricultural employment [18.1% (95% CI: 15.8-20.4%)] women along with those residing in areas of low economic status [15.0% (95% CI: 11.8-18.2%)], of low urbanization [15.6% (95% CI: 13.4-17.7%)], and of low education status [16.0% (95% CI: 14.0-18.1%)]. The multilevel analysis also indicated that women with lower individual-level measures of SES residing in areas with low geographical measures of SES were significantly less likely to receive cervical cancer screening (P < 0.0001). Despite the launch of an organized cancer screening program in China, cervical cancer screening rates remain alarmingly low and significant variations based on geographical regions and measures of SES still exist. It is therefore essential to adopt strategies to better direct limited available public resources to priority groups.

Can China achieve a one-third reduction in premature mortality from non-communicable diseases by 2030?

BACKGROUND: The United Nation's Sustainable Development Goals for 2030 include reducing premature mortality from non-communicable diseases (NCDs) by one third. To assess the feasibility of this goal in China, we projected premature mortality in 2030 of NCDs under different risk factor reduction scenarios. METHODS: We used China results from the Global Burden of Disease Study 2013 as empirical data for projections. Deaths between 1990 and 2013 for cardiovascular disease (CVD), diabetes, chronic respiratory disease, cancer, and other NCDs were extracted, along with population numbers. We disaggregated deaths into parts attributable and unattributable to high systolic blood pressure (SBP), smoking, high body mass index (BMI), high total cholesterol, physical inactivity, and high fasting glucose. Risk factor exposure and deaths by NCD category were projected to 2030. Eight simulated scenarios were also constructed to explore how premature mortality will be affected if the World Health Organization's targets for risk factors reduction are achieved by 2030. RESULTS: If current trends for each risk factor continued to 2030, the total premature deaths from NCDs would increase from 3.11 million to 3.52 million, but the premature mortality rate would decrease by 13.1%. In the combined scenario in which all risk factor reduction targets are achieved, nearly one million deaths among persons 30 to 70 years old due to NCDs would be avoided, and the one-third reduction goal would be achieved for all NCDs combined. More specifically, the goal would be achieved for CVD and chronic respiratory diseases, but not for cancer and diabetes. Reduction in the prevalence of high SBP, smoking, and high BMI played an important role in achieving the goals. CONCLUSIONS: Reaching the goal of a one-third reduction in premature mortality from NCDs is possible by 2030 if certain targets for risk factor intervention are reached, but more efforts are required to achieve risk factor reduction.

[Smoking behavior among the Chinese employed floating population aged 18-59 in 2012].

OBJECTIVE: To understand the prevalence of cigarette smoking among employed floating population in China and to provide evidence for developing prevention and control measures targeted at cigarette smoking among them. METHODS: On the basis of the Disease Surveillance Points (DSPs)System and employed distribution among floating population, the China Non- communicable and Chronic Disease Risk Factor Surveillance in 2012 sampled from 170 DSPs, multi-stage stratified equal-sized cluster sampling method was used and stratified by six occupational groups. Cigarette smoking related information among the employed floating population was collected by face-to-face interviews. The analytical method accounted for the complex sampling design. RESULTS: There were 48 699 subjects, aged 18-59 years old, eligible and included in this analysis among the surveyed employed floating population. Among them, the prevalence of current smoking was 32.5% (95%CI: 32.0%-33.0%). A significantly higher percentage of men 55.3% (95%CI:54.6%-56.0%)relative to women 1.9% (95% CI:1.7%-2.1%)reported current smoking(χ(2) = 2.6, P = 0.103 7). Among men, differences in current smoking rates remained similar across age groups (χ(2) = 2.6, P = 0.103 7), but the current smoking rate tended to be lower with higher education(χ(2) = 140.7, P < 0.000 1). The current smoking rate in men was the highest(58.6% , 95% CI:57.3%-60.0%)in the floating population working in the construction industry. The prevalent of daily cigarette smoking was 27.9% (95% CI: 27.4%-28.4%), with a significantly higher proportion among men 47.8% (95% CI:47.1%-48.5%) than among women 1.3% (95%CI:1.1%-1.4%). Among daily smokers, the mean number of cigarettes smoked was 15.6(95%CI:15.5-15.8)per day(men:15.7 per day; women: 10.3 per day). The number was higher in men 15.7(95% CI:15.6-15.9)than in women 10.3(95% CI:9.3-11.3). Among daily smoking men, the daily consumed cigarettes number increased with the age increased (t = 34.89, P < 0.000 1), whereas the daily consumed cigarettes number decreased with the increase of education level (t = -14.63, P < 0.000 1). The daily consumed cigarettes number in men was the highest (18.2, 95%CI:17.9-18.6)in the floating population working in the construction industry. There were 47.1% of the daily smokers who smoked more than 20 cigarettes per day in the floating population aged 18-59, with a higher percentage among men (47.6%) than women (21.9%). The percentage in men increased with age and education level and the heavy smoking rate was the highest in the construction industry (60.4%). Among current smokers, the percentage of attempting to quit was 10.3% (95%CI: 9.7%-10.8%). A higher proportion of women 14.8% (95% CI:11.1%-18.5%), compared to men 10.1% (95% CI:9.6%-10.7%), reported attempting to quit. The rate of attempting to quit among current smokers increased with age. No significant difference in prevalence of attempting to quit by education level or occupation was seen. The percent of successfully quitting smoking was 6.1% (95%CI:5.7%-6.5%). The proportion was higher in women 7.2% (95%CI:4.6%-9.8%)than in men 6.1% (95%CI:5.7%-6.5%). The percentage of quitting smoking successfully increased with age (χ(2) = 269.0, P < 0.000 1). The percent of people who exposed to secondhand smoking was 68.7% (95%CI: 68.1%-69.3%). The percent was higher among men 76.4% (95%CI:75.5%-77.3%) than in women 64.0% (95%CI:63.2%-64.9%). CONCLUSION: Smoking was more common among men in the employed floating population aged 18-59 years old, especially in the construction industry. Low percent was seen among those who attempting to quit, and the ones who successfully quit were very few.