Trends in Fruit and Vegetable Intake Among the Labor Force Population - China, 2010-2018.

Introduction: This research investigates trends pertaining to the prevalence of low fruit and vegetable consumption among the labor force population in China. The study considered data derived from four nationally representative cross-sectional surveys. Methods: The data under review for this study was derived from the China Chronic Disease and Risk Factor Surveillance (CCDRFS) carried out in 2010, 2013, 2015, and 2018, correspondingly. We utilized a food frequency questionnaire to evaluate the quantity and frequency of fruit and vegetable consumption. The estimated prevalence of low fruit and vegetable consumption was calculated for each survey, while considering factors such as sex, age, location, and socioeconomic status (SES). Participants' SES was ascertained via latent class analysis, serving to identify distinct classes based on criteria such as education, occupation, and household income per capita. Logistic regression was deployed to determine the statistical significance of trends. Results: From 2010 to 2018, there was a notable increase in the average daily consumption of vegetables and fruits among the working population, rising from 418.6 g/day to 491.8 g/day (P<0.01 for trend). During the same period, the prevalence of low fruit and vegetable intake declined from 51.1% to 43.5% [P<0.001 for trend; -1.6% average annual percent change (AAPC)]. This downward trend was prevalent across genders, however, certain subgroups of adults (e.g., those living in rural areas or those of low SES) saw stable consumption levels throughout this period (P>0.05 for trend). Conclusion: Over the past nine years, there has been a notable decline in the prevalence of low fruit and vegetable consumption among the labor force population in China. Moreover, the comparatively deficient intake of fruits and vegetables evident among individuals of lower SES warrants further attention.

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.

Geographic and ethnicity variation in the prevalence of middle-aged and elderly adult obesity in China in 2020.

AIM: The objective of this study is to evaluate the mean body mass index (BMI), general obesity and abdominal obesity in adults aged ≥40 years residing in China in 2020, and to analyse variations in these factors across different geographic areas and subpopulations. METHODS: We utilized data from the National Stroke High-Risk Population Screening programme to calculate and compare the mean BMI and prevalence of obesity across various demographics, including sex, age, urban-rural locality, geographical region (province) and ethnicity status. RESULTS: In our study, we found that the standardized mean BMI level was 24.65 kg/m2 [95% confidence interval (CI): 24.50-22.84] in men and 24.31 kg/m2 (95% CI: 24.15-24.45) in women. Using the criteria from China, we found that the standardized prevalence of general obesity and abdominal obesity was 13.13% (95% CI: 13.05-13.21%) and 33.03% (95 CI: 32.92-33.14%), respectively. Our study also identified significant effects of age, sex, urban-rural locality, province and ethnicity status on the prevalence of obesity. Overall, our study estimated that in 2020, approximately 91.1 million adults aged ≥40 years in China were obese (46.5 million men and 44.6 million women), while 229.2 million adults (110.4 million men and 118.8 million women) were diagnosed with abdominal obesity. CONCLUSION: Our research has revealed compelling new evidence about the obesity epidemic among Chinese adults aged ≥40 years, particularly at the provincial and ethnic levels. As a result, more targeted and effective prevention strategies should be developed to alleviate the burden of obesity.

Knowledge and practices related to salt consumption in China: findings from a national representative cross-sectional survey.

There is limited information on the knowledge and practice of salt-reduction in China. The purpose of this study was to describe the status of the knowledge and practice of salt-reduction among the Chinese population from a nationally representative survey stratified according to hypertension status. The association between hypertensive status and salt-reduction knowledge and practice was calculated using multivariate hierarchical logistic regression adjusting for related confounders. The study included 179,834 participants; 51.7% were women, and the mean age was 44 years. The levels of overall salt-reduction knowledge (7.9%) and practice (37.1%) were low. The percentage of the use of salt-control spoons and low-sodium salt was 10.7% and 12.2%. The aging population (≥60 years) had the lowest levels of salt-reduction knowledge (5.7%) than other age groups (P < 0.0001). People living in rural areas (OR = 0.64; 95% CI: 0.51, 0.81) had lower odds of using salt-control spoons. Females (OR = 1.23; 95% CI: 1.10, 1.36) had higher odds of using salt-control spoons. People living in rural areas (OR = 0.48; 95% CI: 0.36, 0.63) had lower odds of using low-sodium salt. Females (OR = 1.26; 95% CI: 1.13, 1.41) and people living in the southern region (OR = 1.43; 95% CI: 1.11, 1.83) had higher odds of using low-sodium salt. Our work highlights the need to promote education related to hypertension, salt-reduction knowledge and methods among the public and the need to strengthen strategies for the popularization of salt-reduction knowledge and practices among males, people living in rural areas, people living in the northern region and the aging population in China.

City-level population projection for China under different pathways from 2010 to 2100.

Cities play a fundamental role in policy decision-making processes, necessitating the availability of city-level population projections to better understand future population dynamics and facilitate research across various domains, including urban planning, shrinking cities, GHG emission projections, GDP projections, disaster risk mitigation, and public health risk assessment. However, the current absence of city-level population projections for China is a significant gap in knowledge. Moreover, aggregating grid-level projections to the city level introduces substantial errors of approximately 30%, leading to discrepancies with actual population trends. The unique circumstances of China, characterized by comprehensive poverty reduction, compulsory education policies, and carbon neutrality goals, render scenarios like SSP4(Shared Socioeconomic Pathways) and SSP5 less applicable. To address the aforementioned limitations, this study made three key enhancements, which significantly refines and augments our previous investigation. Firstly, we refined the model, incorporating granular demographic data at the city level. Secondly, we redesigned the migration module to consider both regional and city-level population attractiveness. Lastly, we explored diverse fertility and migration scenarios.

The burden of cardiovascular disease attributable to dietary risk factors in the provinces of China, 2002-2018: a nationwide population-based study.

Background: The burden of cardiovascular diseases (CVDs) is on the rise in China, yet a comprehensive and systematic understanding of the temporal trends and distribution of CVD burden attributable to dietary factors across the provinces remains elusive. This study endeavors to provide a comprehensive depiction of the burden of CVDs attributable to dietary risk factors across China's geographical regions from 2002 to 2018. Methods: Data from the China National Nutrition Surveys, the China Chronic Disease and Risk Factor Surveillance, the Hypertension Survey, and the Chinese Centre for Disease Control and Prevention cause-of-death reporting system were used to estimate the intake of dietary factor, the number of deaths, and disability-adjusted life years (DALYs), mortality rate, for ischemic heart disease (IHD), ischemic stroke (IS), hemorrhage and other stroke (HOS) attributable to dietary factors at national and provincial levels in China from 2002 to 2018. Using a comparative risk assessment approach, we estimated the proportion of CVDs burden attributable to suboptimal intake of seven dietary factors, both individually and collectively, among Chinese citizens aged 20 years or older. Finding: The mean consumption of whole grains, soybeans, nuts, vegetables, fruits, red meat, and sugar-sweetened beverages (SSBs) exhibited an upward trend from 2002 to 2018. However, with the exception of red meat and SSBs, the average intake remained below the levels recommended levels outlined in the Chinese national dietary guidelines. Inadequate fruit, whole grain, and vegetables intake were the leading dietary risk factors for IHD, IS and HOS in China, while nuts, soybean and SSB were only associated with IHD mortality. From 2002 to 2018, the number of deaths and mortality rate for CVDs attributable to suboptimal diet among Chinese males were greater than that of females. With increasing age, the diet-related mortality rate for CVDs increased substantially. In 2018, the nationwide mortality rate attributable to diet was found to be 77.9 (95% UI, 77.5-78.1) per 100,000 population for IHD, 34.1 (95% UI, 33.8-34.2) for IS, and 32.8 (95% UI, 32.4-32.8) for HOS. Suboptimal diet was responsible for 16.0 million (95% UI, 13.8-18.4) DALYs and 1137.1 (95% UI, 980.4-1312.3) DALYs per 100,000 population for stroke, and 13.9 million (95% UI, 11.8-16.3) DALYs and 990.2 (95% UI, 841.2-1158.6) DALYs for IHD. Across the provinces of China, in 2018, the highest age-standardized mortality rates of all diet-related deaths were observed in Shandong (92.8 [95% UI, 89.9-93.3]) for IHD, Heilongjiang (38.1 [95% UI, 36.2-38.8]) for IS, and Tibet (68.3 [95% UI, 65.0-70.1]) for HOS. The highest diet related DALYs were observed in Henan (1.4 million [95% UI, 1.2-1.6] for IS, and 1.3 million [95% UI, 1.1-1.5] for IHD). Interpretation: This study provides a comprehensive picture of the geographic variation and temporal trends of the burden of CVDs attributable to dietary risk factors at the national and provincial levels from 2002 to 2018 in China, highlighting the need for geographically targeted intervention strategies to improve the quality of diet and reduce the diet-related burden of CVDs. Funding: National Key Research and Development Program of China (2018YFC1315303), National Natural Science Foundation of China (82103966).

Socioeconomic inequalities in dementia burden related to high body mass index, 2005-2018: findings from 1.25 million Chinese adults.

Background: Dementia has become a major public health concern worldwide, but comprehensive assessments of dementia burden attributable to high body mass index (BMI) in China have not been done. Methods: We used a temporal-spatial Bayesian hierarchical model to estimated BMI levels based on 1.25 million Chinese. We estimated dementia burden attributable to high BMI by age, sex, year, and socioeconomic development in terms of deaths and years of life lost (YLLs) and assessed the effect of population ageing. Findings: The average age-standardised BMI was 24.58 kg/m2 and 24.15 kg/m2 for men and women in 2018, respectively. 12,901 (95% UI, 10,617-15,420) dementia deaths were attributable to high BMI in China in 2018, with 5417 deaths from man and 7421 deaths from woman. The attributable age-standardised YLL rates for dementia increased 27% from 2005 to 2018. The attributable age-standardised mortality rates increased with human development index. People aged 80 years and older had the highest attributable mortality rate, and the rate decreased with decreasing age. Population ageing was an important component of the increase in dementia death. Interpretation: The rapid increase and large inequality highlighted the urgent need for evidence-based policies and interventions. We therefore call for establishing stronger anti-dementia strategies to promote the healthy ageing. Funding: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.

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.

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.

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.

The effect gap of hypertension health management services in poverty and non-poverty counties on the hypertension control: evidence from China Chronic Diseases Risk Factors Surveillance.

BACKGROUND: The Chinese government implemented the health poverty alleviation project (HPAP) since 2016 in poverty counties (PCs). To evaluate the effect of the HPAP on hypertension health management and control in PCs is vital for the policy improvement. METHODS: China Chronic Disease and Risk Factors Surveillance programme were conducted from August 2018 to June 2019. A total of 95,414 participants aged 35 and above from 59 PCs and 129 non-poverty counties (NPCs) were involved in this study. Hypertension prevalence, hypertension control, treatment and health management prevalence, and physical examination proportion were calculated and compared by PCs and NPCs. Logistic regression was employed to explore the association between hypertension control and management services. RESULTS: The hypertension prevalence in NPCs was significantly higher than that in PCs (NPCs 46.1% vs. PCs 41.2%, P < 0.001). The NPCs participants had a higher hypertension control prevalence (NPCs 32.7% vs. PCs 27.3%, P < 0.001) and treatment prevalence (NPCs 86.0% vs. PCs 80.0%, P < 0.001) than that in PCs. The proportion of physical examination in one year in NPCs was significantly higher than that in PCs (NPCs 37.0% vs. PCs 29.5%, P < 0.001). The proportion of diagnosed hypertension patients without hypertension health management in NPCs was significantly higher than that in PCs (NPCs 35.7% vs. PCs 38.4%, P < 0.001). Multivariable logistic regression showed that standardized and non-standardized hypertension health management were positively correlated with hypertension control in NPCs, and standardized hypertension health management was positively correlated with hypertension control in PCs. CONCLUSIONS: These findings show the equity and accessibility gap of health resources still existed between PCs and NPCs under the influence of the HPAP. Hypertensive health management was effective for hypertension control in both PCs and NPCs. However, the quality of management services still needs to be improved.

Potential health and economic impact associated with achieving risk factor control in Chinese adults with diabetes: a microsimulation modelling study.

Background: The prevalence of diabetes has risen sharply in China. Improving modifiable risk factors such as glycaemia and blood pressure could substantially reduce disease burden and treatment costs to achieve a healthier China by 2030. Methods: We used a nationally representative population-based survey of adults with diabetes in 31 provinces in mainland China to assess the prevalence of risk factor control. We adopted a microsimulation approach to estimate the impact of improved control of blood pressure and glycaemia on mortality, quality-adjusted life-years (QALYs), and healthcare cost. We applied the validated CHIME diabetes outcomes model over a 10-year time horizon. Baseline scenario of status quo was evaluated against alternative strategies based on World Health Organization and Chinese Diabetes Society guidelines. Findings: Among 24,319 survey participants with diabetes (age 30-70), 69.1% (95% CI: 67.7-70.5) achieved optimal diabetes control (HbA1c <7% [53 mmol/mol]), 27.7% [26.1-29.3] achieved blood pressure control (<130/80 mmHg) and 20.1% (18.6-21.6) achieved both targets. Achieving 70% control rate for people with diabetes could reduce deaths before age 70 by 7.1% (5.7-8.7), reduce medical costs by 14.9% (12.3-18.0), and gain 50.4 QALYs (44.8-56.0) per 1000 people over 10 years compared to the baseline status quo. The largest health gains were for strategies including strict blood pressure control of 130/80 mmHg, particularly in rural areas. Interpretation: Based on a nationally representative survey, few adults with diabetes in China achieved optimal control of glycaemia and blood pressure. Substantial health gains and economic savings are potentially achievable with better risk factor control especially in rural settings. Funding: Chinese Central Government, Research Grants Council of the Hong Kong Special Administrative Region, China [27112518].

Estimated Burden of Stroke in China in 2020.

Importance: Stroke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited. Objective: To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations. Design, Setting, and Participants: This cross-sectional study was based on a nationally representative survey that included 676 394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China. Main Outcomes and Measures: Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases. Results: The study included 676 394 Chinese adults (395 122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100 000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100 000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P = .02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100 000 person-years; P < .001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100 000 person-years; P < .001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]). Conclusions and Relevance: In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100 000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.

Prevalence and Patterns of Multimorbidity Among Adults Aged 18 Years and Older - China, 2018.

What is already known about this topic?: Multimorbidity is becoming more common and poses a major challenge to healthcare systems. However, the prevalence and patterns of multimorbidity among Chinese adults aged ≥18 years are largely unknown. What is added by this report?: This study found that 46.5% of Chinese adults had multimorbidity in 2018. And the prevalence of multimorbidity prevalence is increased with age. Prevalence of multimorbidity was higher among men, Han Chinese, adults with lower educational level, and those with lower household income. The most common multimorbidity pattern is a combination of three chronic conditions, hypertension, dyslipidemia, and obesity. What are the implications for public health practices?: As multimorbidity diversifies characteristics and patterns, guideline development, clinical management, and public intervention should consider the complexity of multimorbidity.

The Status of Blood Lipids Among Children and Adolescents - China, 2016-2017.

What is already known about this topic?: Dyslipidemia is attributed to cardiovascular disease (CVD). A recent report suggests dyslipidemia prevalence has increased among children and adolescents. What is added by this report?: Dyslipidemia prevalence was 19.43% among Chinese children and adolescents aged 6-17 years in 2016-2017. The abnormal blood lipid prevalence and the average blood lipid levels showed a diversified distribution across demographics. What are the implications for public health practice?: Continued monitoring of abnormal blood lipids among Chinese children and adolescents, especially triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C), may inform public health interventions to promote long-term cardiovascular health and prevent CVD in adulthood.

Sleep Status Among Children and Adolescents Aged 6-17 Years - China, 2016-2017.

What is already known about this topic?: There has been little to no description of sleep status among children and adolescents nationwide in recent years. What is added by this report?: This report assesses the sleep duration and sleep patterns of children and adolescents in China. Approximately half of the adolescents did not get the recommended amount of sleep on school days, and more than half overslept on weekends. What are the implications for public health practice?: The importance of children and adolescents meeting recommended sleep durations needs greater emphasis, especially among older age groups and those in urban areas.

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.

Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey.

OBJECTIVE: To assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups. DESIGN: Six rounds of a national survey, China. SETTING: China Chronic Disease and Risk Factors Surveillance, 2004-18. PARTICIPANTS: 642 523 community dwelling adults aged 18-69 years (30 501 in 2004, 47 353 in 2007, 90 491 in 2010, 156 836 in 2013, 162 293 in 2015, and 155 049 in 2018). MAIN OUTCOME MEASURES: Hypertension was defined as a blood pressure of ≥140/90 mm Hg or taking antihypertensive drugs. The main outcome measures were hypertension prevalence and proportion of people with hypertension who were aware of their hypertension, who were treated for hypertension, and whose blood pressure was controlled below 140/90 mm Hg. RESULTS: The standardised prevalence of hypertension in adults aged 18-69 years in China increased from 20.8% (95% confidence interval 19.0% to 22.5%) in 2004 to 29.6% (27.8% to 31.3%) in 2010, then decreased to 24.7% (23.2% to 26.1%) in 2018. During 2010-18, the absolute annual decline in prevalence of hypertension among women was more than twice that among men (-0.83 percentage points (95% confidence interval -1.13 to -0.52) v -0.40 percentage points (-0.73 to -0.07)). Despite modest improvements in the awareness, treatment, and control of hypertension since 2004, rates remained low in 2018, at 38.3% (36.3% to 40.4%), 34.6% (32.6% to 36.7%), and 12.0% (10.6% to 13.4%). Of 274 million (95% confidence interval 238 to 311 million) adults aged 18-69 years with hypertension in 2018, control was inadequate in an estimated 240 million (215 to 264 million). Across all surveys, women with low educational attainment had higher prevalence of hypertension than those with higher education, but the finding was mixed for men. The gap in hypertension control between urban and rural areas persisted, despite larger improvements in diagnosis and control in rural than in urban areas. CONCLUSIONS: The prevalence of hypertension in China has slightly declined since 2010, but treatment and control remain low. The findings highlight the need for improving detection and treatment of hypertension through the strengthening of primary care in China, especially in rural areas.

The burden of cardiovascular disease attributable to high systolic blood pressure across China, 2005-18: a population-based study.

BACKGROUND: Temporal trends and geographical variations in cardiovascular disease attributable to high systolic blood pressure in China are not yet fully understood. The aim of this study was to quantify the cardiovascular disease burden attributable to high systolic blood pressure at national and provincial levels in China. METHODS: In this population-based study, we evaluated systolic blood pressure and estimated the number of deaths, age-standardised mortality rates, and years of life lost (YLLs) due to cardiovascular disease and its subcategories (including ischaemic heart disease, ischaemic stroke, haemorrhagic stroke, and other cardiovascular diseases) attributable to high systolic blood pressure, at the national level and by 31 provincial levels, in China, from 2005 to 2018. We pooled blood pressure data of 1·30 million adults aged 25 years and older from the China Chronic Disease and Risk Factor Surveillance project, the China National Nutrition Survey, and the China Hypertension Survey. We applied a temporal-spatial Bayesian hierarchical model to estimate age-specific, sex-specific, province-specific, and year-specific average systolic blood pressure, and a comparative risk assessment method to compute the cardiovascular disease burden attributable to high systolic blood pressure by age, sex, year, and province. FINDINGS: Nationally, age-standardised mean systolic blood pressure was 132·5 mm Hg (95% uncertainty interval [UI] 124·6-140·3) in men and 129·4 mm Hg (121·7 to 137·2) in women. 2·67 million (95% UI 2·61 to 2·72) cardiovascular disease deaths in China were attributable to high systolic blood pressure, including 1·12 million deaths (1·07 to 1·16) due to ischaemic heart disease, 0·63 million deaths (0·60 to 0·65) due to ischaemic stroke, 0·58 million deaths (0·57 to 0·60) due to haemorrhagic stroke, and 0·34 million deaths (0·32 to 0·36) due to other cardiovascular disease. The age-standardised cardiovascular disease mortality rates associated with high systolic blood pressure were 268·99 per 100 000 people (95% UI 264·11 to 273·51) in 2005 and 220·84 per 100 000 people (216·30 to 224·76) in 2018, a percentage change of -17·90%; the rate changed by an average of -1·50% (95% UI -1·55% to -1·45%) per year from 2005 to 2018 nationally. YLL rates for total cardiovascular disease caused by high systolic blood pressure varied substantially across provinces, ranging from 3078·33 (95% UI 2807·40 to 3303·57) per 100 000 people in Beijing to 7189·98 (95% UI 6817·18 to 7507·99) per 100 000 people in Heilongjiang in 2018. Age-standardised YLL rates for ischaemic heart disease and ischaemic stroke attributable to high systolic blood pressure were particularly high in northeastern provinces, including Heilongjiang, Liaoning, and Jilin. INTERPRETATION: The deaths and YLLs for cardiovascular disease attributable to high systolic blood pressure in China increased between 2005 and 2018, and age-standardised cardiovascular disease mortality rates decreased in the same timeframe. Our findings could help policy makers in promoting blood pressure control measures and implementing effective and locally adapted preventive interventions to reduce the prevalence of high systolic blood pressure and reduce the burden of systolic blood pressure-related cardiovascular disease in China. FUNDING: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.