Salt consumption and the risk of chronic diseases among Chinese adults in Ningbo city.

BACKGROUND: Chronic diseases have become one of essential public health concerns, leading causes of mortality in China. It is related to the changes in dietary pattern and dietary behavior. The objectives are to assess daily salt intake in Chinese people living in Ningbo and to examine its relationship with health outcomes. METHODS: Our study used data from health and nutrition survey in 2017. This study included 2811 adults aged 18-79 years (48% males) from urban and rural areas in Ningbo. A food frequency questionnaire together with demographic, physical and medical questionnaires was used to collect dietary intake, demographic, lifestyle and medical information. Ordinal logistic regression was used in the statistical analysis. RESULTS: The mean daily salt intake (13.0 g/day) of the participants was higher than the Chinese dietary reference intake (DRI, 6 g/d), which was related to higher risk of pre-hypertension and hypertension. Stratified by gender, education and lifestyle factors, daily salt intake was only significant in the blood pressure category (male: P = 0.048; less education: P = 0.003; urban: P = 0.006; no regular physical activity: P = 0.005, no regular smoking: P = 0.006). Ordinal logistic regression model shows that daily salt intake was significantly associated with higher odds of developing hypertension. CONCLUSION: The daily salt intake of the majority of citizens living in Ningbo exceeded Chinese DRI and may increase the risk of hypertension. Moreover, public health intervention of salt restriction is necessarily needed for the prevention and control the ongoing epidemic of chronic diseases.

Health literacy and its effect on chronic disease prevention: evidence from China's data.

BACKGROUND: Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual's health outcomes, confounding factors are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention. METHODS: A population-based sample of 8194 participants aged 15-69 years old in Ningbo were used from China's 2017 National Health Literacy Surveillance Data. We use multivariate regression analysis to disentangle the relationship between health literacy and chronic disease prevention. RESULTS: We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. This might arise because having one or more chronic conditions is associated with better knowledge about chronic diseases, thus improve their health literacy. More importantly, we find health literacy is associated with a reduction in the likelihood of having a comorbid condition. However, this protective effect is only found among urban residents, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes. CONCLUSION: Our findings highlight the important role of health literacy in preventing comorbidities instead of preventing the first chronic condition. Moreover, family support could help improve health literacy and result in beneficial effects on health.

The burden of ischemic heart disease related to ambient air pollution exposure in a coastal city in South China.

OBJECTIVE: Air pollution is considered one of the most important risk factors for ischemic heart disease (IHD), which is a major public health concern. The disease burden of IHD has continued to rise in China in the past two decades. However, epidemiological studies examining the associations between air pollution and IHD have been scarce in China, and the only studies were conducted in severe air pollution areas, where air pollution levels seriously exceed the World Health Organization Air Quality Guidelines. Whether the influence of air pollution on IHD in areas with relatively low levels of air pollution differs from the influence of high pollution levels in heavily studied areas was unknown until now. Furthermore, the estimation of the disease burden of IHD related to air pollution has been very limited. METHODS: We conducted a time-series study to estimate the short-term burden of ambient air pollution on IHD using the indicator of years of life lost (YLL), based on 10 322 IHD deaths from 2011 to 2015 in Ningbo, a coastal city in South China. RESULTS: The mean concentrations of fine particle (PM2.5), sulfur dioxide (SO2) and nitrogen dioxide (NO2) were 49.58 µg/m3, 21.34 µg/m3 and 43.41 µg/m3, respectively. A 10 µg/m3 increase in PM2.5, SO2 and NO2 was associated with changes in YLL of 0.71 (95%CI: - 0.21,1.64), 3.31 (95%CI: 0.78, 5.84), and 2.27 (95%CI: 0.26, 4.28) years, respectively. Relatively stronger impacts were found for gaseous pollutants than PM2.5. A larger increase in YLL was found in the younger population than in the older population for NO2 exposure. In addition, estimations of the effects of SO2 and NO2 on YLL were higher for males than females. SO2 exposure was positively associated with YLL in widowed group. CONCLUSIONS: The findings highlighted the importance of stringent air pollution control, especially for gaseous pollutants. Furthermore, using the indicator of YLL, considering the occurrence of death at different ages, provided more information for resource allocation and protection of vulnerable populations.

Projections for temperature-related years of life lost from cardiovascular diseases in the elderly in a Chinese city with typical subtropical climate.

OBJECTIVE: Extreme temperature is an important risk factor for cardiovascular diseases, and the elderly are particularly vulnerable to temperature variation. Global warming and the increasingly aging population are two major global challenges for human health; thus, an urgent need exists to project the temperature-related cardiovascular disease burden regarding both of the aforementioned factors. We aimed to the project temperature-related burden of cardiovascular diseases using years of life lost (YLL) in the elderly in a Chinese city with typical subtropical climate. METHODS: A retrospective time-series study was first conducted to estimate cardiovascular disease burden associated with temperature in the elderly from 2008 to 2015 in Ningbo, China. Then, future projections considering demographic change and adaptation under 19 global-scale climate models (GCMs) and 3 different Representative Concentration Pathways (RCPs) scenarios for the 2050s and 2070s were estimated. RESULTS: The exposure-response curve for temperature on YLL from cardiovascular diseases was U-shaped, with increased YLL for both higher- and lower- than optimal temperature. The projected annual increase in heat-related YLL was outweighed by the decrease in cold-related YLL. However, monthly analysis demonstrated that temperature-related YLL will increase significantly in August. Additionally, heat-related YLL is projected to increase 3.1-11.5 times for the 2050s and 2070s relative to baseline, when considering demographic changes, even with 30% adaptation taken into consideration. CONCLUSIONS: Although annual YLL from cardiovascular diseases in the elderly associated with temperature will decrease in the future, heat-related YLL will increase tremendously, which indicates that more adaptation strategies and greenhouse emission control measures should be undertaken to reduce the future heat-related burden of cardiovascular diseases in the elderly.

The short term burden of ambient fine particulate matter on chronic obstructive pulmonary disease in Ningbo, China.

BACKGROUND: Numerous studies have found associations between ambient fine particulate matter (PM2.5) and increased mortality risk. However, little evidence is available on associations between PM2.5 and years of life lost (YLL). We aimed to estimate the YLL due to chronic obstructive pulmonary disease (COPD) mortality related to ambient PM2.5 exposure. METHODS: A time-series study was conducted based on the data on air pollutants, meteorological conditions and 18,472 registered COPD deaths in Ningbo, China, 2011-2015. The effects of PM2.5 on YLL and daily death of COPD were estimated, after controlling long term trend, meteorological index and other confounders. RESULTS: The impact of PM2.5 on YLL due to COPD lasted for 5 days (lag 0-4). Per 10 µg/m3 increase in PM2.5 was associated with 0.91 (95%CI: 0.16, 1.66) years increase in YLL. The excess YLL of COPD mortality were 8206 years, and 0.38 day per person in Ningbo from 2011 to 2015. The exposure-response curve of PM2.5 and YLL due to COPD showed a non-linear pattern, with relatively steep at low levels and flattened out at higher exposures.. Furthermore, the effects were significantly higher in the elderly than those in the younger. CONCLUSIONS: Our findings explored burden of PM2.5 on YLL due to COPD and highlight the importance and urgency of ambient PM2.5 pollution control and protection of the vulnerable populations.

Knowledge and perceptions of air pollution in Ningbo, China.

BACKGROUND: The residents' knowledge, attitudes and practices related to ambient air pollution and health will help to improve the understanding of environmental protection and make environmental health policies more targeted and effective. This study aimed at knowing the attitudes and behaviors towards ambient air pollution and health. METHODS: A cross-sectional survey was conducted in Ningbo, China in January 2015. Personal information and questions pertaining to the knowledge, attitudes and practices towards ambient air pollution and health were collected through questionnaire investigations. Descriptive statistics, chi-square tests and multiple unconditional logistic regression analysis were used. RESULTS: The questionnaire was completed by 1604 respondents (59.41 % women). The awareness rate was 64.59 % and varied significantly with age, levels of education, and occupation (all p < 0.05). Only 5.80 % of the total participants were satisfied with the air quality in Ningbo in 2014. Most respondents (78.80 %) expressed concern about the possible aggravation of the haze. More than 80 % of participants believed that it will take at least 3-5 years or longer before the air quality is improved. Television and internet resources have replaced books and newspapers as the primary sources for obtaining knowledge about haze and related protective measures. 85.22 % of respondents were concerned about air quality index (AQI). Most of the residents have taken protective measures indoors during haze weather. 48.50 % have worn face masks when going outside, the most frequently type of face masks selected were cotton (39.85 %) or gauze face masks (36.24 %). Age and occupation were the main factors associated with the level of knowledge about air pollution (p < 0.05). CONCLUSIONS: There were a relatively high knowledge awareness rate, strong health protection consciousness and high enthusiasm for air pollution control among Ningbo residents. The elderly people and less-educated residents are the targetable population for improving environment.

[Relationship between sulfur dioxide pollution and upper respiratory outpatients in Jiangbei, Ningbo].

OBJECTIVE: To describe the daily average concentration of sulfur dioxide (SO2) in Ningbo, and to analysis the health impacts it caused in upper respiratory disease. METHODS: With outpatients log and air pollutants monitoring data matched in 2011-2013, the distributed lag non-linear models were used to analysis the relative risk of the number of upper respiratory patients associated with SO2, and also excessive risk, and the inferred number of patients due to SO2 pollution. RESULTS: The daily average concentration of SO2 didn't exceed the limit value of second class area. The coefficient of upper respiratory outpatient number and daily average concentration of SO2 matched was 0.44,with the excessive risk was 10% to 18%, the lag of most SO2 concentrations was 4 to 6 days. It could be estimated that about 30% of total upper respiratory outpatients were caused by SO2 pollution. CONCLUSION: Although the daily average concentration of SO2 didn't exceed the standard in 3 years, the health impacts still be caused with lag effect.

A nomogram based on LI-RADS features, clinical indicators and quantitative contrast-enhanced MRI parameters for predicting glypican-3 expression in hepatocellular carcinoma.

Purpose: Noninvasively assessing the tumor biology and microenvironment before treatment is greatly important, and glypican-3 (GPC-3) is a new-generation immunotherapy target for hepatocellular carcinoma (HCC). This study investigated the application value of a nomogram based on LI-RADS features, quantitative contrast-enhanced MRI parameters and clinical indicators in the noninvasive preoperative prediction of GPC-3 expression in HCC. Methods and materials: We retrospectively reviewed 127 patients with pathologically confirmed solitary HCC who underwent Gd-EOB-DTPA MRI examinations and related laboratory tests. Quantitative contrast-enhanced MRI parameters and clinical indicators were collected by an abdominal radiologist, and LI-RADS features were independently assessed and recorded by three trained intermediate- and senior-level radiologists. The pathological and immunohistochemical results of HCC were determined by two senior pathologists. All patients were divided into a training cohort (88 cases) and validation cohort (39 cases). Univariate analysis and multivariate logistic regression were performed to identify independent predictors of GPC-3 expression in HCC, and a nomogram model was established in the training cohort. The performance of the nomogram was assessed by the area under the receiver operating characteristic curve (AUC) and the calibration curve in the training cohort and validation cohort, respectively. Results: Blood products in mass, nodule-in-nodule architecture, mosaic architecture, contrast enhancement ratio (CER), transition phase lesion-liver parenchyma signal ratio (TP-LNR), and serum ferritin (Fer) were independent predictors of GPC-3 expression, with odds ratios (ORs) of 5.437, 10.682, 5.477, 11.788, 0.028, and 1.005, respectively. Nomogram based on LI-RADS features (blood products in mass, nodule-in-nodule architecture and mosaic architecture), quantitative contrast-enhanced MRI parameters (CER and TP-LNR) and clinical indicators (Fer) for predicting GPC-3 expression in HCC was established successfully. The nomogram showed good discrimination (AUC of 0.925 in the training cohort and 0.908 in the validation cohort) and favorable calibration. The diagnostic sensitivity and specificity were 76.9% and 92.3% in the training cohort, 76.8% and 93.8% in the validation cohort respectively. Conclusion: The nomogram constructed from LI-RADS features, quantitative contrast-enhanced MRI parameters and clinical indicators has high application value, can accurately predict GPC-3 expression in HCC and may help noninvasively identify potential patients for GPC-3 immunotherapy.

The burden of ozone pollution on years of life lost from chronic obstructive pulmonary disease in a city of Yangtze River Delta, China.

OBJECTIVE: Ambient ozone is one of the most important air pollutants with respect to its impacts on human health and its increasing concentrations globally. However, studies which explored the burden of ozone pollution on chronic obstructive pulmonary disease (COPD) and estimated the relevant economic loss were rare. OBJECTIVE: We explored the relationships between ambient ozone exposure and years of life lost (YLL) from COPD mortality and estimated the relevant economic loss in Ningbo, in the Yangtze River Delta of China, 2011-2015. METHODS: A time-series study was conducted to explore the effects of ozone on YLL from COPD. Seasonal stratified analyses were performed, and the effect modification of demographic factors was estimated. In addition, the related economic loss was calculated using the method of the value per statistical life year (VSLY). RESULTS: Averaged daily mean maximum 8-h average ozone concentration was 40.90 ppb in Ningbo, China, 2011-2015. The effect of short term ambient ozone exposure on COPD YLL was more pronounced in the cool season than in the warm season, with 10 ppb increment of ozone corresponding to 7.09(95%CI: 3.41, 10.78) years increase in the cool season and 0.31 (95%CI: -2.15, 2.77) years change in the warm season. The effect was higher in the elderly than the young. Economic loss due to excess COPD YLL related to ozone exposure accounted for 7.30% of the total economic loss due to COPD YLL in Ningbo during the study period. CONCLUSIONS: Our findings highlight that ozone exposure was related to tremendous disease burden of COPD in Ningbo, China. The effects were more pronounced in the cool season, and the elderly were more susceptible populations.

Temporal variation in associations between temperature and years of life lost in a southern China city with typical subtropical climate.

Though some studies have explored the association between temperature and years of life lost (YLL), limited evidence is available regarding the effect of temporal variation on the temperature-YLL relationship, especially in developing countries. We explored temporal variation in the associations between temperature and YLL before and after 2013 heat waves (period I: Jan 2008 to Sep 2013, period II: Oct 2013 to Dec 2015) in Ningbo, a southern China city with typical subtropical climate. The heat associations showed an increasing trend. The number of YLL due to heat-related respiratory mortality was significantly higher in period II (46.03, 95% CI: 11.97, 80.08) than in period I (7.21, 95% CI: -10.04, 24.46) among married individuals. In contrast, the cold associations presented an attenuating trend, and the number of YLL due to non-accidental mortality was significantly lower in period II (262.32, 95% CI: -304.18, 828.83) than in period I (916.78, 95% CI: 596.05, 1237.51). These results indicate more effort still needed to be made to reduce heat-related YLL even after periods of extreme heat. Furthermore, using YLL provided complementary information for identifying vulnerable subgroups, which has important implications for the planning of public health interventions.

Ambient air pollution and years of life lost in Ningbo, China.

To evaluate the burden of air pollution on years of life lost (YLL) in addition to mortality, we conducted a time series analysis based on the data on air pollution, meteorological conditions and 163,704 non-accidental deaths of Ningbo, China, 2009-2013. The mean concentrations of particulate matter with aerodynamic diameter <10 µm, particulate matter with aerodynamic diameter <2.5 µm, sulfur dioxide and nitrogen dioxide were 84.0 µg/m(3), 60.1 µg/m(3), 25.1 µg/m(3) and 41.7 µg/m(3), respectively. An increase of 10-µg/m(3) in particulate matter with aerodynamic diameter <10 µm, particulate matter with aerodynamic diameter <2.5 µm, sulfur dioxide and nitrogen dioxide was associated with 4.27 (95% confidence interval [CI] 1.17-7.38), 2.97 (95% CI -2.01-7.95), 29.98 (95% CI 19.21-40.76) and 16.58 (95% CI 8.19-24.97) YLL, respectively, and 0.53% (95% CI 0.29-0.76%), 0.57% (95% CI 0.20-0.95%), 2.89% (95% CI 2.04-3.76%), and 1.65% (95% CI 1.01-2.30%) increase of daily death counts, respectively. The impact of air pollution lasted for four days (lag 0-3), and were more significant in the elderly than in the young population for both outcomes. These findings clarify the burden of air pollution on YLL and highlight the importance and urgency of air pollution control in China.