Advancing nuanced pollution control: Local improvements and spatial spillovers of policies on key enterprises.

This paper examines the impact of air pollution control policies targeting key polluting enterprises, highlighting a strategic shift towards precision pollution control that concentrates on high-emission, high-risk businesses. The paper explores the efficacy of these policies and their potential spatial spillover effects, utilizing panel data from 259 Chinese cities from 2013 to 2021. Employing the difference-in-differences (DID) model and spatial Durbin model, the study analyzes both the direct local effects and the broader spatial consequences of these regulatory measures on air quality. The findings indicate a significant reduction in air pollutant concentrations in urban areas, attributing this improvement to factors such as industrial restructuring, increased investment in science and technology, and economic growth. Spatial econometric analysis further reveals a substantial positive correlation in air quality among Chinese cities. However, estimates of the spillover effect indicate that while such policies successfully reduce pollution locally, they could unintentionally degrade air quality in adjacent areas. The study highlights the need for nuanced policy strategies to mitigate unintended spatial spillovers and enhance overall effectiveness. It recommends tailored policies that integrate environmental and socioeconomic objectives, national and regional coordination for consistent enforcement, technology-driven compliance strategies, and incentives for sustainable enterprise practices.

Rapid increasing burden of diabetes and cardiovascular disease caused by high body mass index in 1.25 million Chinese adults, 2005-2018.

BACKGROUND: Temporal trends and geographical variations in disease burden for diabetes mellitus (DM) and cardiovascular disease (CVD) attributable to high body mass index (BMI) in China have not been fully elucidated. METHODS: We estimated deaths and years of life lost (YLLs) for DM and CVD attributable to high BMI by age, sex, year, and region from 2005 to 2018 based on pooled data of 1.25 million adults. FINDINGS: Approximately 497,430 (95% uncertainty interval [UI], 470,520-525,720) deaths for DM and CVD were attributable to high BMI in China in 2018, with 453,750 deaths from CVD and 43,700 deaths from DM. Between 2005 and 2018, there was a 17.35% increase in age-standardized mortality rate for DM and CVD attributable to high BMI. The high BMI-related DM and CVD YLL rates increased from 127.46 (95% UI 108.70-148.62) per 100,000 people aged 20-24 years to 5,735.54 (95% UI 4,844.16-6,713.53) per 100,000 people aged ≥80 years, respectively. The highest age-standardized mortality rate for high BMI-related DM and CVD in northeast, northwest, and circum-Bohai Sea regions of China. CONCLUSION: The disease burden for DM and CVD attributable to high BMI increased substantially between 2005 and 2018. Urgent measures are required at both national and regional levels for resource mobilization to slow the growing burden. FUNDING: The work was supported by the National Key Research and Development Program of China, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.

Evaluation of the Community-Based Hypertension Management Programs in China.

Purpose: The National Essential Public Health Services Package (NEPHSP), a set of community-based hypertension management programs, was launched by the Chinese government in 2009. However, the data are limited for the comprehensive evaluation of NEPHSP on hypertension management. This study was to estimate the effect of NEPHSP on hypertension control nationwide in China. Methods: Data were from China Hypertension Survey (CHS). The participants (n = 119,412) aged ≥35 years with hypertension were included in the analysis. Further, a subset of 64,188 diagnosed hypertensive patients were analyzed to evaluate the effect of NEPHSP by comparing the ones covered and not covered by NEPHSP. Blood pressure (BP) was measured by trained staff using a validated digital portable monitor in local communities or clinics. Results: Among adults aged ≥35 years with hypertension, the coverage of NEPHSP was 25.6% and increased with age. The coverage was significantly higher in women than in men (P < 0.001). Among the 64, 188 diagnosed hypertensive patients, compared to the control group (not covered by NEPHSP), the mean systolic and diastolic BPs were 2 mmHg and 1.6 mmHg lower in NEPHSP group, respectively. The rate of treatment for hypertension was significantly higher in NEPHSP group than the control group (93.0% vs. 81.4%, P < 0.001), and the rate of BP control was also significantly higher in NEPHSP group than the control group (35.9% vs. 29.6%, P < 0.001). Furthermore, similar trends were found in rural and urban, as well as in men and women. Conclusions: Our results showed that NEPHSP is effective in improving hypertension treatment and control in hypertensive patients in China. However, the coverage of NEPHSP was still low.

Social determinants status and hypertension: A Nationwide Cross-sectional Study in China.

To explore the association between unbalanced social determinants status and hypertension (HTN) in China, we conducted a cross-sectional survey in a sample of 299 220 Chinese in 2012 to 2015. Social determinants status were measured with: (a) district-level:Per capita GDP (Per_GDP), the number of hospital beds per 1000 residents (Per 1000_bed) and tertiary industry added value (TIAV); (b) individual-level: education and employment conditions. Compared with the poorest level of Per_GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12 (1.09-1.14) and 0.99 (0.96-1.02)] and higher possibility of HTN awareness, treatment, and control. Higher risk of HTN and lower possibility of awareness, treatment, and control were associated with elevated Per 1000_bed in rural area. Higher possibility of HTN control was associated with the higher TIAV (Ptrend  < .001). Those with middle (OR, 95%CI: 0.86, 0.84-0.88) and senior (OR, 95%CI: 0.72, 0.69-0.76) education had a decreased risk of HTN and higher HTN control possibility compared to primary. And participants in retirement/unemployment conditions had a higher risk of HTN and higher possibility of HTN awareness, treatment, and control compared with the job-holders. This study provides evidence from China that social determinants status has a detectable association with HTN. People with a higher economic area living, lower level of education, or retirement/ unemployment conditions has a higher risk of HTN, especially for male or rural residents. And lower possibility of HTN awareness, treatment, and control were associated with worse economic development and social circumstances environment, lower education level, and employment/student conditions.

Clinical outcomes and economic impact of the 2017 ACC/AHA guidelines on hypertension in China.

The 2017 guidelines on the diagnosis and treatment of high blood pressure in adults were published by the American College of Cardiology and the American Heart Association. The impact on clinical outcomes and costs needs to be estimated prior to adopting these guidelines in China. Data from a nationally representative sample in China were analyzed. The prevalence and treatment were calculated based on the criteria of the 2017 guidelines and 2018 Chinese guidelines among participants aged ≥35 years old. Direct medical costs, as well as the averted disability adjusted of life years and cost saving from cardiovascular disease events prevented by controlling hypertension, were also estimated. The prevalence and treatment rate of hypertension were 32.0% and 43.4% according to the 2018 Chinese guidelines. Based on the 2017 guidelines, another 24.5% of the adult population (estimated 168.1 million) would be classified as having hypertension; of whom, about 32.1 million would need to be pharmaceutically treated to reach the current treatment rate of 43.4%. As a result, an estimated additional 42.7 billion US dollars  of the direct medical cost would be required for lifetime therapy. By preventing cardiovascular events, the new guidelines would reduce lifetime costs by 3.77 billion US dollars, while preventing 1.41 million disability adjusted of life years lost. Application of the 2017 guidelines in China will substantially increase the prevalence of hypertension and produce a large increase in therapy costs, although it would prevent cardiovascular disease events and save disability adjusted of life years.

Cost-effectiveness of nitrendipine and hydrochlorothiazide or metoprolol to treat hypertension in rural community health centers in China.

OBJECTIVES: The objective of this article is to compare blood pressure (BP)-lowing effects of nitrendipine and hydrochlorothiazide and nitrendipine and metoprolol, and estimate the economic effect of these therapies on hypertension. METHODS: Outpatients (N = 793) 18-70 years of age with stage 2 or severe hypertension (SBP ≥ 160 mmHg and/or DBP ≥ 100 mmHg) were recruited from four randomly selected rural community health centers in Beijing and Jilin. After drug wash out, they were randomly divided into nitrendipine and hydrochlorothiazide group or nitrendipine and metoprolol group. The costs of drug treatment for hypertension were calculated and general estimation, whereas effectiveness was measured as a reduction in SBP and DBP at the end of a 24-week study period. RESULTS: Overall, 623 patients were eligible for the study and after a 24-week follow-up, SBP and DBP were 131.2/82.2 mmHg for the nitrendipine and hydrochlorothiazide group and 131.4/82.9 mmHg for the nitrendipine and metoprolol group and these were not significantly different (P = 0.7974 SBP and P = 0.1166 DBP). Comparing with nitrendipine and metoprolol, the cost of nitrendipine and hydrochlorothiazide was less, and its effectiveness was similar. The cost/effect ratio (US$/mmHg) was 1.4 for SBP and 2.8 for DBP for the nitrendipine and hydrochlorothiazide group, and 1.9 and 3.8 for the nitrendipine and metoprolol group's SBP and DBP values, respectively. The incremental cost per patient for achieving target BP was 5.1. Adverse events were mild or moderate and there were no differences between treatment groups. CONCLUSION: Treating hypertension with nitrendipine and hydrochlorothiazide was cost-effective than nitrendipine and metoprolol, and these data will allow more reasonable and efficient allocation of limited resources in low-income countries.

[Risk assessment of coastal ecosystem in Beibu Gulf, Guangxi of South China].

Based on the marine ecological investigation in the coastal area of Beibu Gulf, Guangxi in September 2009, a GIS-based evaluation was conducted on the present status of ecological environment quality, including seawater quality, nutrient level, biomass, primary productivity, biodiversity, and ecological buffer capacity, in the area in autumn, and the integrated ecological risk index (ERI) was adopted to assess the risk of the coastal ecosystem in the Gulf. In September 2009, the study area had a better ecological environment quality. Most of the risk indicators were at medium or lower level, and the total area was overall at low ecological risk level. The ERI showed that there was an obvious spatial heterogeneity in the distribution of the ecological risk. The nearer to the harbors, the higher the risk was.