Associations of Diabetes and Prediabetes With Mortality and Life Expectancy in China: A National Study.

OBJECTIVE: To investigate the excess mortality and life-years lost associated with diabetes and prediabetes in China. RESEARCH DESIGN AND METHODS: This national cohort study enrolled 135,405 participants aged 18 years or older from the general population in China. Cox proportional hazards regression models were used to estimate adjusted mortality rate ratio (RR). The life table method was used to estimate life expectancy. RESULTS: Among the 135,405 participants, 10.5% had diabetes and 36.2% had prediabetes in 2013. During a median follow-up of 6 years, 5517 deaths were recorded, including 1428 and 2300 deaths among people with diabetes and prediabetes, respectively. Diabetes and prediabetes were significantly associated with increased risk of all-cause (diabetes: RR, 1.61 [95% CI 1.49, 1.73]; prediabetes: RR, 1.08 [95% CI 1.01, 1.15]), and cardiovascular disease (diabetes: RR, 1.59 [95% CI 1.41, 1.78]; prediabetes: RR, 1.10 [95% CI 1.00, 1.21]) mortality. Additionally, diabetes was significantly associated with increased risks of death resulting from cancer, respiratory disease, liver disease, and diabetic ketoacidosis or coma. Compared with participants with normoglycemia, life expectancy of those with diabetes and prediabetes was shorter, on average, by 4.2 and 0.7 years at age 40 years, respectively. The magnitude of the associations of diabetes and prediabetes with all-cause and cardiovascular disease mortality varied by age and residence. CONCLUSIONS: In this national study, diabetes and prediabetes were significantly associated with reduced life expectancy and increased all-cause and cause-specific mortality risks. The disparities in excess mortality associated with diabetes and prediabetes between different ages and residences have implications for diabetes and prediabetes prevention and treatment programs.

Cancer survival statistics in China 2019-2021: a multicenter, population-based study.

Background: A milestone goal of the Healthy China Program (2019-2030) is to achieve 5-year cancer survival at 43.3% for all cancers combined by 2022. To assess the progress towards this target, we analyzed the updated survival for all cancers combined and 25 specific cancer types in China from 2019 to 2021. Methods: We conducted standardized data collection and quality control for cancer registries across 32 provincial-level regions in China, and included 6,410,940 newly diagnosed cancer patients from 281 cancer registries during 2008-2019, with follow-up data on vital status available until December 2021. We estimated the age-standardized 5-year relative survival overall and by site, age group, and period of diagnosis using the International Cancer Survival Standard Weights, and quantified the survival changes to assess the progress in cancer control. Results: In 2019-2021, the age-standardized 5-year relative survival for all cancers combined was 43.7% (95% confidence interval [CI], 43.6-43.7). The 5-year relative survival varied by cancer type, ranging from 8.5% (95% CI, 8.2-8.7) for pancreatic cancer to 92.9% (95% CI, 92.4-93.3) for thyroid cancer. Eight cancers had 5-year survival of over 60%, including cancers of the thyroid, breast, testis, bladder, prostate, kidney, uterus, and cervix. The 5-year relative survival was generally lower in males than in females. From 2008 to 2021, we observed significant survival improvements for cancers of the lung, prostate, bone, uterus, breast, cervix, nasopharynx, larynx, and bladder. The most significant improvement was in lung cancer. Conclusions: Progress in cancer control was evident in China. This highlights the importance of a comprehensive approach to control and prevent cancer.

Mortality risk and burden of sudden cardiac arrest associated with hot nights, heatwaves, cold spells, and non-optimum temperatures in 0.88 million patients: An individual-level case-crossover study.

Sudden cardiac arrest (SCA) is a global health concern, imposing a substantial mortality burden. However, the understanding of the impact of various extreme temperature events, when accounting for the effect of daily average temperature on SCA, remains incomplete. Additionally, the assessment of SCA mortality burden associated with temperatures from an individual-level design is limited. This nationwide case-crossover study collected individual SCA death records across all (2844) county-level administrative units in the Chinese Mainland from 2013 to 2019. Four definitions for hot nights and ten for both cold spells and heatwaves were established using various temperature thresholds and durations. Conditional logistic regression models combined with distributed lag nonlinear models were employed to estimate the cumulative exposure-response relationships. Based on 887,662 SCA decedents, this analysis found that both hot nights [odds ratio (OR): 1.28; attributable fraction (AF): 1.32 %] and heatwaves (OR: 1.40; AF: 1.29 %) exhibited significant added effects on SCA mortality independent of daily average temperatures, while cold spells were not associated with an elevated SCA risk after accounting for effects of temperatures. Cold temperatures [below the minimum mortality temperature (MMT)] accounted for a larger mortality burden than high temperatures (above the MMT) [AF: 12.2 % vs. 1.5 %]. Higher temperature-related mortality risks and burdens were observed in patients who experienced out-of-hospital cardiac arrest compared to those with in-hospital cardiac arrest. This nationwide study presents the most compelling and comprehensive evidence of the elevated mortality risk and burden of SCA associated with extreme temperature events and ambient temperatures amid global warming.

National age-specific mortality trends for cervical and breast cancers in urban-rural areas of China from 2009 to 2021: a population-based analysis.

BACKGROUND: Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021. METHODS: Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China's National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups. RESULTS: From 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35-64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5-7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: - 0.7%, 95% CI - 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI - 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: - 2.7%, 95% CI - 4.6 to - 0.7%, P = 0.007) in urban areas. Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas, periods, and regions in China. CONCLUSIONS: Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities. Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.

Ambient fine particulate matter and Life's essential 8 and mortality in adults in China: A Nationwide retrospective cohort study.

BACKGROUND: Enhanced cardiovascular health (CVH) is linked to reduced mortality risks, whereas long-term exposure to fine particulate matter (PM2.5), elevates these risks. Whether long-term exposure to PM2.5 counteracts the health benefits of high CVH is unknown. The study aims to evaluate whether the association of CVH assessed by Life's Essential 8 (LE8) with death was consistent between participants with different PM2.5 exposures. METHODS: We included 134,727 participants in the field survey of China Chronic Disease and Risk Factor Surveillance which was conducted from August 2013 to June 2014. The deaths of participants were obtained by linking to the National Mortality Surveillance System (2013-2018). The environmental data is obtained by satellite inversion. The participants' CVH scores were calculated using the LE8 method. Hazard ratio (HR) and 95% confidence intervals (95%CI) for mortality were calculated using Cox regression models. RESULTS: A total of 2,936 all-cause deaths and 1,158 cardiovascular disease (CVD) deaths were recorded. Compared to those with low CVH, adults with high CVH demonstrated a reduced risk of all-cause mortality, irrespective of their PM2.5 exposure levels (P < 0.05, all P for interaction >0.05). Furthermore, in comparison to those with low CVH and highest PM2.5 exposure, adults with high CVH and lowest PM2.5 exposure exhibited HR of 0.18 (95%CI, 0.12-0.25) for all-cause mortality and 0.13 (95%CI, 0.08-0.22) for CVD mortality. CONCLUSIONS: High CVH is associated with reduced all-cause mortality risk, regardless of PM2.5 exposure levels. For Chinese adults, sustaining high CVH is advisable, irrespective of their residential location.

Liver Cancer Mortality Disparities at a Fine Scale Among Subpopulations in China: Nationwide Analysis of Spatial and Temporal Trends.

Background: China has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups. Objective: The purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China. Methods: Data from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude. Results: In China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05% to 29.07% and from 10.09% to 21.71%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (R=0.225; P<.001), while in women, it showed a negative correlation (R=0.083; P=.04). High LASMR areas among men aligned with subtropical zones, like Cwa and Cfa. The age group 65 years and older, the southern region, and the Cwa climate zone had the highest YLL rates at 4850.50, 495.50, and 440.17 per 100,000, respectively. However, the overall trends in these groups showed a decline over the period. Conclusions: Despite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China.

Burden of non-communicable diseases in China and its provinces, 1990-2021: Results from the Global Burden of Disease Study 2021.

BACKGROUND: Non-communicable diseases (NCDs) are the primary causes of disability and death. The aim of this study is to analyze the disease burden of NCDs in China from 1990 to 2021. METHODS: This study used data on NCDs in China and its provinces from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study analyzed the disease burden of NCDs in 2021 and its changes from 1990 to 2021 using indicators including deaths and disability-adjusted life years (DALYs). RESULTS: Between 1990 and 2021, the NCD burden in China exhibited an upward trend. In 2021, China had 10.6 (95% uncertainty interval [UI]: 9.0-12.2) million deaths and 349.3 (95% UI: 301.5-401.2) million DALYs due to NCDs, accounting for 91.0% (95% UI: 90.4-91.7%) of all deaths and 86.7% (95% UI: 86.0-87.4%) of all DALYs. NCDs caused a lower disease burden in females than in males. Cardiovascular diseases and neoplasms were the main NCD level 2 causes of deaths and DALYs, resulting in 5.1 (95% UI: 4.3-5.9) and 2.8 (95% UI: 2.3-3.4) million deaths and 100.2 (95% UI: 84.6-116.6) million and 71.2 (95% UI: 59.3-85.2) million DALYs in 2021, respectively. Chronic respiratory diseases were the third leading cause of NCD deaths, while musculoskeletal disorders were the third leading cause of NCD DALYs. Qinghai, Xizang, and Heilongjiang had the highest age-standardized mortality rates and age-standardized DALY rates (per 100,000) for NCDs, while Hong Kong Special Administration Region (SAR), Macao SAR, and Shanghai recorded the lowest age-standardized mortality rates and age-standardized DALY rates. CONCLUSIONS: NCDs disease burden in China and exhibited heterogeneity across sexes provinces. China needs to focus on addressing key NCDs and implement intervention measures tailored to the disease distribution characteristics to reduce the NCD burden.

Associations between socioeconomic inequalities and progression to psychological and cognitive multimorbidities after onset of a physical condition: a multicohort study.

Background: Chronic physical conditions (e.g., heart diseases, diabetes) increase with population ageing, contributing to psychological and cognitive multimorbidities. Yet, little is known about socioeconomic inequalities in this process. We examined the associations between socioeconomic status (SES) and progression to psychological and cognitive multimorbidities after onset of a physical condition. Methods: We used harmonized individual-level data from five prospective cohort studies across 24 countries in the US, Europe and Asia, with repeated morbidity measurements between 2002 and 2021. Participants with at least one new-onset physical conditions (hypertension, diabetes, heart diseases, stroke, chronic lung diseases, cancer, or arthritis) were followed up for progression to physical-psychological multimorbidity, physical-cognitive multimorbidity, and physical-psychological-cognitive multimorbidity. SES was determined based on educational level and total household wealth at the onset of a physical condition. Time to and incidence rates of progressing psychological and cognitive multimorbidities were estimated in analyses stratified by SES. Fine-Gray subdistribution hazard models and multi-state models were used to estimate the associations between SES and progression to psychological and cognitive multimorbidities. Findings: Among 20,250 participants aged ≥45 years (mean age at a physical condition onset 65.38 years, standard deviation 8.37) with at least one new-onset physical conditions in the analysis, 7928 (39.2%) progressed to psychological and cognitive multimorbidities during a median follow-up of 8.0 years (168,575 person-years). The mean survival time free from physical-psychological-cognitive multimorbidity was 11.96 years (95% confidence interval 11.57-12.34) in low SES individuals, compared to 15.52 years (15.40-15.63) in high SES individuals, with the corresponding incidence rate of 18.44 (16.32-20.82) and 3.15 (2.48-4.01) per 1000 person-years, respectively. The associations of education, household wealth and SES with multimorbidities followed a dose-dependent relation, with subdistribution hazard ratios per decreasing SES category being 1.24 (1.19-1.29) for physical-psychological multimorbidity, 1.47 (1.40-1.54) for physical-cognitive multimorbidity, and 1.84 (1.72-1.97) for physical-psychological-cognitive multimorbidity. The strongest SES-multimorbidities associations were observed in participants with arthritis, hypertension or diabetes. In multi-state models SES was linked to all five transitions from physical condition to physical-psychological multimorbidity, physical-cognitive multimorbidity and physical-psychological-cognitive multimorbidity. Interpretation: Socioeconomic inequalities are associated with the progression of a chronic physical condition, with the lower SES groups had both an earlier time to and a higher incidence of psychological and cognitive multimorbidities. These findings underscore the need for more effective equity-oriented policies and healthcare practices to address reduced psychological wellness and cognitive maintenance among individuals with low SES and physical conditions. Funding: Zhejiang University Hundred Talents Program Research Initiation Fund, Fundamental Research Funds for the Central Universities in China, Wellcome Trust, Medical Research Council, National Institute on Aging, Academy of Finland.

Ambient particulate matter and chronic obstructive pulmonary disease mortality: a nationwide, individual-level, case-crossover study in China.

BACKGROUND: Short-term exposure to particulate matter air pollution has been associated with the exacerbations of COPD, but its association with COPD mortality was not fully elucidated. We aimed to assess the association between short-term particulate matter exposure and the risk of COPD mortality in China using individual-level data. METHODS: We derived 2.26 million COPD deaths from a national death registry database in Chinese mainland between 2013 and 2019. Exposures to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) were assessed by satellite-based models of a 1 × 1 km resolution and assigned to each individual based on residential address. The associations of PM2.5 and PM2.5-10 with COPD mortality were examined using a time-stratified case-crossover design and conditional logistic regressions with distributed lag models. We further conducted stratified analyses by age, sex, education level, and season. FINDINGS: Short-term exposures to both PM2.5 and PM2.5-10 were associated with increased risks of COPD mortality. These associations appeared and peaked on the concurrent day, attenuated and became nonsignificant after 5 or 7 days, respectively. The exposure-response curves were approximately linear without discernible thresholds. An interquartile range increase in PM2.5 and PM2.5-10 concentrations was associated with 4.23% (95% CI: 3.75%, 4.72%) and 2.67% (95% CI: 2.18%, 3.16%) higher risks of COPD mortality over lag 0-7 d, respectively. The associations of PM2.5 and PM2.5-10 attenuated slightly but were still significant in the mutual-adjustment models. A larger association of PM2.5-10 was observed in the warm season. INTERPRETATION: This individual-level, nationwide, case-crossover study suggests that short-term exposure to PM2.5 and PM2.5-10 might act as one of the environmental risk factors for COPD mortality. FUNDING: This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.2-YQ31), and the Science and Technology Commission of Shanghai Municipality (21TQ015).

The trends of non-accidental mortality burden attributed to compound hot-dry events in China and its provinces in a global warming world.

BACKGROUND: Global warming has provoked more co-occurrence of hot extreme and dry extreme, namely compound hot-dry events (CHDEs). However, their health impacts have seldom been investigated. This study aimed to characterize CHDEs and assess its mortality burden in China from 1990 to 2100. METHODS: CHDEs were defined as a day when daily maximum temperature > its 90th percentile and Standardized Precipitation Index < its 50th percentile. A two-stage approach, including a distributed lag nonlinear model (DLNM) and a multivariate meta-analysis, was used to estimate exposure-response associations of CHDEs with mortality in 358 counties/districts during 2006-2017 in China, which was then applied to assess the national mortality burden attributable to CHDEs from 1990 to 2100. FINDINGS: We observed a significant increasing trend of CHDEs in China until mid-21st century, and then flatted, while the duration and intensity of CHDEs continuously increased across the 21st century. CHDEs were much riskier (ER=17.82 %, 95 %CI: 14.17 %-21.60 %) than independent hot events (ER=5.86 %,95 %CI: -0.04 %,12.45 %) or dry events (ER=0.07 %,95 %CI: -1.22 %, 1.38 %), and there was significantly additive interaction between hot events and dry events (AP=0.10,95 %CI: 0.04, 0.16). Females (ER=24.28 %, 95 %CI: 19.21 %-29.56 %), the elderly (ER=23.28 %, 95 %CI: 18.23 %-28.55 %), and people living in humid area (ER=18.98 %, 95 %CI: 15.08 %-23.02 %) had higher mortality risks than their counterparts. Mortality burden attributed to CHDEs significantly increased during historical observation and became stable since mid-21st century in China. INTERPRETATION: CHDEs would significantly increase mortality with higher risk for females, the elderly and people living in humid areas. Mortality burden has significantly increased during historical observation and will keep relatively steady since mid-21st century.

Burden of digestive system diseases in China and its provinces during 1990-2019: Results of the 2019 Global Disease Burden Study.

BACKGROUND: Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies. However, comprehensive reports on the burden of digestive system diseases in China are lacking. Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces. METHODS: This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence, mortality rate, disability-adjusted life years (DALYs), years of life disability, years of life lost, and changes in the burden of digestive diseases across 31 Chinese provinces from 1990 to 2019. The analysis of disease burden primarily examines the characteristics of sub-disease distribution, time trends, age distribution, and sex distribution. Additionally, we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index (SDI). RESULTS: In 2019, there were 499.2 million cases of digestive system diseases in China, resulting in 1,557,310 deaths. Stomach cancer, colon and rectal cancer, and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases. Meanwhile, cirrhosis and other chronic liver diseases, gastroesophageal reflux disease, and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases. The risk of gastric cancer sharply increases among men after the age of 40 years, leading to a significant disparity in burden between men and women. As the SDI increased, the DALYs associated with digestive system diseases in China and its provinces showed a downward trend. CONCLUSION: Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI, providing valuable insights that can assist public health officials in the estimation of the disease burden in this area.

Joint Effect of Short-Term Exposure to Fine Particulate Matter and Ozone on Mortality: A Time Series Study in 272 Chinese Cities.

Short-term exposure to PM2.5 or O3 can increase mortality risk; however, limited studies have evaluated their interaction. A multicity time series study was conducted to investigate the synergistic effect of PM2.5 and O3 on mortality in China, using mortality data and high-resolution pollutant predictions from 272 cities in 2013-2015. Generalized additive models were applied to estimate associations of PM2.5 and O3 with mortality. Modification and interaction effects were explored by stratified analyses and synergistic indexes. Deaths attributable to PM2.5 and O3 were evaluated with or without modification of the other pollutant. The risk of total nonaccidental mortality increased by 0.70% for each 10 µg/m3 increase in PM2.5 when O3 levels were high, compared to 0.12% at low O3 levels. The effect of O3 on total nonaccidental mortality at high PM2.5 levels (1.26%) was also significantly higher than that at low PM2.5 levels (0.59%). Similar patterns were observed for cardiovascular or respiratory diseases. The relative excess risk of interaction and synergy index of PM2.5 and O3 on nonaccidental mortality were 0.69% and 1.31 with statistical significance, respectively. Nonaccidental deaths attributable to short-term exposure of PM2.5 or O3 when considering modification of the other pollutant were 28% and 31% higher than those without considering modification, respectively. Our results found synergistic effects of short-term coexposure to PM2.5 and O3 on mortality and suggested underestimations of attributable risks without considering their synergistic effects.

Heat Exposure and Dementia-Related Mortality in China.

Importance: Although existing research has found daily heat to be associated with dementia-related outcomes, there is still a gap in understanding the differing associations of nighttime and daytime heat with dementia-related deaths. Objectives: To quantitatively assess the risk and burden of dementia-related deaths associated with short-term nighttime and daytime heat exposure and identify potential effect modifications. Design, Setting, and Participants: This case-crossover study analyzed individual death records for dementia across all mainland China counties from January 1, 2013, to December 31, 2019, using a time-stratified case-crossover approach. Statistical analysis was conducted from January 1, 2013, to December 31, 2019. Exposures: Two novel heat metrics: hot night excess (HNE) and hot day excess (HDE), representing nighttime and daytime heat intensity, respectively. Main Outcomes and Measures: Main outcomes were the relative risk and burden of dementia-related deaths associated with HNE and HDE under different definitions. Analysis was conducted with conditional logistic regression integrated with the distributed lag nonlinear model. Results: The study involved 132 573 dementia-related deaths (mean [SD] age, 82.5 [22.5] years; 73 086 women [55.1%]). For a 95% threshold, the median hot night threshold was 24.5 °C (IQR, 20.1 °C-26.2 °C) with an HNE of 3.7 °C (IQR, 3.1 °C-4.3 °C), and the median hot day threshold was 33.3 °C (IQR, 29.9 °C-34.7 °C) with an HDE of 0.6 °C (IQR, 0.5 °C-0.8 °C). Both nighttime and daytime heat were associated with increased risk of dementia-related deaths. Hot nights' associations with risk of dementia-related deaths persisted for 6 days, while hot days' associations with risk of dementia-related deaths extended over 10 days. Extreme HDE had a higher relative risk of dementia-related deaths, with a greater burden associated with extreme HNE at more stringent thresholds. At a 97.5% threshold, the odds ratio for dementia-related deaths was 1.38 (95% CI, 1.22-1.55) for extreme HNE and 1.46 (95% CI, 1.27-1.68) for extreme HDE, with an attributable fraction of 1.45% (95% empirical confidence interval [95% eCI], 1.43%-1.47%) for extreme HNE and 1.10% (95% eCI, 1.08%-1.11%) for extreme HDE. Subgroup analyses suggested heightened susceptibility among females, individuals older than 75 years of age, and those with lower educational levels. Regional disparities were observed, with individuals in the south exhibiting greater sensitivity to nighttime heat and those in the north to daytime heat. Conclusions and Relevance: Results of this nationwide case-crossover study suggest that both nighttime and daytime heat are associated with increased risk of dementia-related deaths, with a greater burden associated with nighttime heat. These findings underscore the necessity of time-specific interventions to mitigate extreme heat risk.

Drivers of associations between daytime-nighttime compound temperature extremes and mortality in China.

BACKGROUND: Temperature extremes are anticipated to become more frequent and more intense under the context of climate change. While current evidence on health effects of compound extreme temperature event is scarce. METHODS: This nationwide cross-sectional study collected daily data on weather and mortality for 161 Chinese districts/counties during 2007-2013. A quasi-Poisson generalized linear model was first applied to assess effects of daytime-only, nighttime-only and compound daytime-nighttime heat wave (and cold spell) on cause-specific mortality. Then a random-effect meta-analysis was used to produce pooled estimates at national level. Stratification analyses were performed by relative humidity, individual and regional characteristics. RESULTS: Here we show that mortality risks of compound daytime-nighttime temperature extremes are much higher than those occurring only in the daytime or nighttime. Humid weather further exaggerates the mortality risk during heat waves, while dry air enhances the risk during cold weather. People who are elderly, illiterate, and those with ischemic heart disease and respiratory disease are particularly vulnerable to extreme temperature. At the community-level, population size, urbanization rate, proportion of elderly and PM2.5 are positively associated with increased risks associated with heat waves. Temperature, humidity and normalized difference vegetation index are positively associated with the effects of cold weather, with an opposite trend for latitude and diurnal temperature range. CONCLUSIONS: This nationwide study highlights the importance of incorporating compound daytime-nighttime extreme temperature events and humid conditions into early warning systems and urban design/planning.

Ongoing climate change has exaggerated the frequency and intensity of severe climate events, leading to substantial health and socioeconomic consequences. We assessed deaths in China during periods when many extreme climate events occurred at the same or similar times. We looked at deaths occurring during periods when both daytime and nighttime temperatures were very hot or cold. We found more serious health effects were seen when temperatures remained hot or cold during the day and night compared to when it was just hot or cold during the day or night. Other factors including humidity, preexisting heart or respiratory disease and age also impacted the risk of death. Our study highlights the detrimental health effects of many extreme climate events occurring together and the need for both people and governments to consider approaches to reduce these negative effects.

Prevalence and Burden of Multiple Sclerosis in China, 1990-2019: Findings From the Global Burden of Disease Study 2019.

BACKGROUND AND OBJECTIVES: Multiple sclerosis (MS) is the leading cause of neurologic disability in young adults, but the burden caused by MS in China is lacking. We aimed to comprehensively describe the prevalence and health loss due to MS by demographic and geographical variables from 1990 to 2019 across China. METHODS: Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). We used GBD methodology to systematically analyze the prevalence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to MS by age, sex, and location from 1990 to 2019 in mainland China and its provinces. We also compared the MS burden in China with the world and other Group of 20 (G20) countries. RESULTS: In 2019, 42,571 (95% uncertainty interval [UI] 33,001-53,329) individuals in China had MS, which doubled from 1990. The age-standardized prevalence rate of MS was 2.32 per 100,000 (95% UI 1.78-2.91), which increased by 23.31% (95% UI 20.50-25.89) from 1990, with most of the growth occurring after 2010. There was a positive latitudinal gradient with the increasing prevalence from south to north across China. The total DALYs caused by MS were 71,439 (95% UI 58,360-92,254) in 2019, ranking China third among G20 countries. Most of the MS burden in China derived from premature mortality, with the higher fraction of YLLs than that at the global level and most other G20 countries. From 1990 to 2019, the age-standardized DALY and YLL rate had nonsignificant changes; however, the age-standardized YLD rate substantially increased by 23.33% (95% UI 20.50-25.89). The geographic distribution of MS burden varied at the provincial level in China, with a slight downward trend in the age-standardized DALY rates along with increasing Socio-Demographic Index over the study period. DISCUSSION: Although China has a low risk of MS, the substantial and increasing prevalent cases should not be underestimated. The high burden due to premature death and geographic disparity of MS burden reveals insufficient management of MS in China, highlighting the needs for increased awareness and effective intervention.

Differential associations of fine and coarse particulate air pollution with cause-specific pneumonia mortality: A nationwide, individual-level, case-crossover study.

BACKGROUND: The connections between fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) and daily mortality of viral pneumonia and bacterial pneumonia were unclear. OBJECTIVES: To distinguish the connections between PM2.5 and PM2.5-10 and daily mortality due to viral pneumonia and bacterial pneumonia. METHODS: Using a comprehensive national death registry encompassing all areas of mainland China, we conducted a case-crossover investigation from 2013 to 2019 at an individual level. Residential daily particle concentrations were evaluated using satellite-based models with a spatial resolution of 1 km. To analyze the data, we employed the conditional logistic regression model in conjunction with polynomial distributed lag models. RESULTS: We included 221,507 pneumonia deaths in China. Every interquartile range (IQR) elevation in concentrations of PM2.5 (lag 0-2 d, 37.6 µg/m3) was associated with higher magnitude of mortality for viral pneumonia (3.03%) than bacterial pneumonia (2.14%), whereas the difference was not significant (p-value for difference = 0.38). An IQR increase in concentrations of PM2.5-10 (lag 0-2 d, 28.4 µg/m3) was also linked to higher magnitude of mortality from viral pneumonia (3.06%) compared to bacterial pneumonia (2.31%), whereas the difference was not significant (p-value for difference = 0.52). After controlling for gaseous pollutants, their effects were all stable; however, with mutual adjustment, the associations of PM2.5 remained, and those of PM2.5-10 were no longer statistically significant. Greater magnitude of associations was noted in individuals aged 75 years and above, as well as during the cold season. CONCLUSION: This nationwide study presents compelling evidence that both PM2.5 and PM2.5-10 exposures could increase pneumonia mortality of viral and bacterial causes, highlighting the more robust effects of PM2.5 and somewhat higher sensitivity of viral pneumonia.

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).

Disease burden of Parkinson's disease in China and its provinces from 1990 to 2021: findings from the global burden of disease study 2021.

Background: Parkinson's disease (PD) has become a public health concern with global ageing. However, comprehensive assessments of the temporal and geographical trend of PD disease burden in China remain insufficient. This study aimed to examine the burden of PD by age, gender, and geographical region in China during 1990-2021. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analysed the incidence, prevalence, mortality, and DALY burden of PD in 33 Chinese provinces/regions. We compared the national figure with the global average and the corresponding estimates from the G20 countries. The estimated annual percentage change (EAPC) was used to quantify the temporal trends of PD burden during 1990-2021. We further assessed the PD burden by age and gender during 1990-2021. We used a decomposition analysis to investigate the changes in the number of new cases, patients, and deaths of PD during 1990-2021. Findings: In 2021, China recorded the highest age-standardised incidence and prevalence of PD among the G20 countries, at 24.3 per 100,000 and 245.7 per 100,000, respectively, figures that were much higher than the global average. During 1990-2021, the age-standardised incidence of PD in China increased by 89.7%, and the age-standardised prevalence by 167.8%, both marking the largest increases among the G20 countries. In contrast, the age-standardised mortality for PD has significantly decreased since 1990, whereas the age-standardised DALY rate for PD has remained relatively unchanged since 1990. The PD burden gradually increased with age, especially in the elderly population aged ≥65 years. During 1990-2021, the burden in males consistently surpassed that in females, with the gender difference widening over time. The increase in new cases and patients of PD was primarily driven by changes in age-specific rates, while the rise in PD-related deaths was largely attributable to population ageing. The disease burden of PD varied considerably across the Chinese provinces. In 2021, age-standardised incidence and prevalence of PD were generally higher in China's southeastern coastal regions than in the western regions, and age-standardised DALY rates were higher in the northern regions than in other regions. Interpretation: The disease burden of PD in China has consistently risen over the past three decades, particularly among elderly men. The increasing causative factors and population aging highlight the need for enhancing public health intervention and resource allocation, especially in etiological research, early diagnosis, preventive strategies, and region-specific management for PD. Funding: Ministry of Science and Technology of the People's Republic of China (2022YFC2304900, 2022YFC2505100); National Key R&D Program of China (2022YFC2505100, 2022YFC2505103, 2018YFC1315300); Outstanding Young Scholars Support Program (grant number: 3111500001); Epidemiology modeling and risk assessment (grant number: 20200344), and Xi'an Jiaotong University Young Scholar Support Grant (grant number: YX6J004).

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.