Differentiating the impact of fine and coarse particulate matter on cause-specific cerebrovascular mortality: An individual-level, case-crossover study.

BACKGROUND AND OBJECTIVES: Many studies suggested that short-term exposure to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) was linked to elevated risk of cerebrovascular disease. However, little is known about the potentially differential effects of PM2.5 and PM2.5-10 on various types of cerebrovascular disease. METHODS: We collected individual cerebrovascular death records for all residents in Shanghai, China from 2005 to 2021. Residential daily air pollution data were predicted from a satellite model. The associations between particulate matters (PM) and cerebrovascular mortality were investigated by an individual-level, time-stratified, case-crossover design. The data was analyzed by the conditional logistic regression combined with the distributed lag model with a maximum lag of 7 days. Furthermore, we explored the effect modifications by sex, age and season. RESULTS: A total of 388,823 cerebrovascular deaths were included. Monotonous increases were observed for mortality of all cerebrovascular diseases except for hemorrhagic stroke. A 10 µg/m3 rise in PM2.5 was related to rises of 1.35% [95% confidence interval (CI): 1.04%, 1.66%] in mortality of all cerebrovascular diseases, 1.84% (95% CI: 1.25%, 2.44%) in ischemic stroke, 1.53% (95% CI: 1.07%, 1.99%) in cerebrovascular sequelae and 1.56% (95% CI: 1.08%, 2.05%) in ischemic stroke sequelae. The excess risk estimates per each 10 µg/m3 rise in PM2.5-10 were 1.47% (95% CI: 1.10%, 1.84%), 1.53% (95% CI: 0.83%, 2.24%), 1.93% (95% CI: 1.38%, 2.49%) and 2.22% (95% CI: 1.64%, 2.81%), respectively. The associations of both pollutants with all cerebrovascular outcomes were robust after controlling for co-pollutants. The associations were greater in females, individuals > 80 years, and during the warm season. CONCLUSIONS: Short-term exposures to both PM2.5 and PM2.5-10 may independently increase the mortality risk of cerebrovascular diseases, particularly of ischemic stroke and stroke sequelae.

Large-Area Soluble Covalent Organic Framework Oligomer Coating for Organic Solution Nanofiltration Membranes.

Covalent organic frameworks (COFs) are a family of engaging membrane materials for molecular separation, which remain challenging to fabricate in the form of thin-film composite membranes due to slow crystal growth and insoluble powder. Here, an additive approach is presented to construct COF-based thin-film composite membranes in 10 min via COF oligomer coating onto poly(ether ether ketone) (PEEK）ultrafiltration membranes. By the virtue of ultra-thin liquid phase and liquid-solid interface-confined assembly, the COF oligomers are fast stacked up and grow along the interface with the solvent evaporation. Benefiting from the low out-plane resistance of COFs, COF@PEEK composite membranes exhibit high solvent permeances in a negative correlation with solvent viscosity. The well-defined pore structures enable high molecular sieving ability (Mw = 300 g mol-1 ). Besides, the COF@PEEK composite membranes possess excellent mechanical integrities and steadily operate for over 150 h in the condition of high-pressure cross flow. This work not only exemplifies the high-efficiency and scale-up preparation of COF-based thin-film composite membranes but also provides a new strategy for COF membrane processing.

A randomized controlled study on systematic nursing care based on health empowerment theory and its effect on the self-care and functional abilities of patients with spinal fractures.

OBJECTIVE: In this study, we aimed to explore the effectiveness of systematic nursing care based on health empowerment theory on the self-care and functional abilities of patients with spinal fractures. METHODS: We selected a total of 50 patients with spinal fractures from our hospital and randomly divided them into the control group and the observation group, with 25 patients in each group. Patients in the control group received conventional nursing care, while those in the observation group received systematic nursing care grounded in the health empowerment theory. We recorded and compared the self-care ability, functional ability, knowledge about the condition, and pain scores of patients in the two groups before and after the nursing intervention. RESULTS: There was no significant difference in the baseline characteristics between the two groups (P > 0.05), and there was no significant difference in self-care ability, functional ability, knowledge about the condition, or the visual analog scale (VAS) score between the two groups before treatment (P > 0.05). After treatment, outcomes in the observation group in terms of self-care ability, functional ability, and knowledge about the condition were significantly better than those in the control group (P < 0.05), while the VAS score in the observation group was significantly lower than that in the control group (P < 0.05). CONCLUSION: Compared with conventional nursing care, patients with spinal fractures who received systematic nursing inputs based on health empowerment theory reported significant improvements in pain, self-care, functional ability, and knowledge of the condition, and this is an approach that is worthy of promotion in clinical use.

Mechanochemical asymmetric three-component Mannich reaction involving unreactive arylamines.

We report here a mechanochemical protocol for an asymmetric three-component Mannich reaction involving unreactive arylamines with simple cyclic ketones and arylaldehydes catalyzed by (S)-proline with a chiral diol. In this mechanochemical protocol, ball milling enables reaction acceleration and enantioselectivity control. The reported asymmetric three-component Mannich reactions usually involve reactive arylamines such as p-anisidine and phenylamine, while the catalytic asymmetric Mannich reactions involving unreactive arylamines in solution did not proceed smoothly or gave low yields and enantioselectivities. However, the use of ball-milling techniques overcomes the deficiency of the batch systems in solution and avoids the use of toxic organic solvents. The desired products were obtained in moderate-to-good yields (49%-80%) with good-to-high enantioselectivities (up to 99% ee). This is the first example of a mechanochemically activated catalytic asymmetric three-component Mannich reaction involving unreactive arylamines.

Correction: Mechanochemical asymmetric three-component Mannich reaction involving unreactive arylamines.

Correction for 'Mechanochemical asymmetric three-component Mannich reaction involving unreactive arylamines' by Xiaoyun Hu et al., Org. Biomol. Chem., 2023, https://doi.org/10.1039/d3ob00954h.

Secular trends of low birth weight, preterm birth, and small for gestational age in Shanghai from 2004 to 2020: an age-period-cohort analysis.

BACKGROUND: Although highly heterogeneous among countries, the incidence rates of low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA) have been increasing globally over the past two decades. To better understand the cause of these secular trends, this study aimed to investigate the effects of age, period, and birth cohort on LBW, PTB, and SGA rates in Shanghai. METHODS: Data from 2,958,695 singleton live births at 24-41 gestational weeks between 2004 and 2020 were obtained for this study. Age-period-cohort models based on Poisson regression were used to evaluate the independent effects of maternal age, delivery period, and maternal birth cohort on the trends in LBW, PTB, and SGA. RESULTS: The overall prevalence rates of LBW, PTB, and SGA were 2.9%, 4.7%, and 9.3%, respectively, and significant changes were observed (average annual change: + 10.7‰, + 9.1‰, -11.9‰) from 2004 to 2020. Cohort effect increased steadily, from 1960 (risk ratio [RR] = 0.71, 95% confidence interval [CI]: 0.65-0.78) to 1993 (RR = 0.97, 95% CI: 0.94-1.01) for LBW and from 1960 (RR = 0.69, 95% CI: 0.64-0.75) to 2004 (RR = 1.02, 95% CI: 0.94-1.12) for PTB. A strong cohort effect was found with the highest risk of SGA (RR = 1.82, 95% CI: 1.72-1.93) in 1960 and the lowest risk (RR = 0.57, 95% CI: 0.54-0.61) in 2004, compared with the reference cohort of 1985. There was a "U-shaped" maternal age effect on LBW and PTB and a weak period effect on the three birth outcomes. CONCLUSIONS: Our findings suggested a significant independent effect of age, period, and birth cohort on the three birth outcomes. The increasing rates of LBW and PTB motivated us to focus on young and advanced pregnant women. Meanwhile, the prevalence of SGA decreased steadily, illustrating the need for further research on the mechanisms underlying these trends.

Adverse birth outcomes among offspring born to women diagnosed with cancer: a population-based cohort study.

BACKGROUND: With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and oncology management. However, the effects of different types of cancer at different gestational stages have not been widely reported. OBJECTIVE: This study aimed to describe the epidemiologic characteristics of pregnancy-associated cancers (during and 1 year after pregnancy) and evaluate the association between adverse birth outcomes and maternal cancers. METHODS: Of 983,162 cases, a history of maternal cancer, including pregestational cancer, pregnancy-associated cancer, and subsequent cancer, was identified in 16,475 cases using a health information network. The incidence and 95% confidence interval of pregnancy-associated cancer were calculated with the Poisson distribution. The adjusted risk ratio with 95% confidence interval of the association between adverse birth outcomes and maternal cancer were estimated using the multilevel log-binomial model. RESULTS: A total of 38,295 offspring were born to mothers with a cancer history. Of these, 2583 (6.75%) were exposed to pregnancy-associated cancer, 30,706 (80.18%) had a subsequent cancer diagnosis, and 5006 (13.07%) were exposed to pregestational cancer. The incidence of pregnancy-associated cancer was 2.63 per 1000 pregnancies (95% confidence interval, 2.53‰-2.73‰), with cancer of the thyroid (1.15‰), breast (0.25‰), and female reproductive organs (0.23‰) being the most common cancer types. The increased risks of preterm birth and low birthweight were significantly associated with cancer diagnosed during the second and third trimester of pregnancy, whereas increased risks of birth defects (adjusted risk ratio, 1.48; 95% confidence interval, 1.08-2.04) were associated with cancer diagnosed in the first trimester. Increased risks of preterm birth (adjusted risk ratio, 1.16; 95% confidence interval, 1.02-1.32), low birthweight (adjusted risk ratio, 1.24; 95% confidence interval, 1.07-1.44), and birth defects (adjusted risk ratio, 1.22; 95% confidence interval, 1.10-1.35) were observed in thyroid cancer survivors. CONCLUSION: Careful monitoring of fetal growth should be implemented for women diagnosed with cancer in the second and third trimester to ensure timely delivery and balance the benefits of neonatal health and cancer treatment. The higher incidence of thyroid cancer and increased risk of adverse birth outcomes among thyroid cancer survivors suggested that the regular thyroid function monitoring and regulation of thyroid hormone levels are important in maintaining pregnancy and promoting fetal development among thyroid cancer survivors before and during pregnancy.

Association between excessive fetal growth and maternal cancer in Shanghai, China: a large, population-based cohort study.

The prevalence of high birth weight or large for gestational age (LGA) infants is increasing, with increasing evidence of pregnancy-related factors that may have long-term impacts on the health of the mother and baby. We aimed to determine the association between excessive fetal growth, specifically LGA and macrosomia, and subsequent maternal cancer by performing a prospective population-based cohort study. The data set was based on the Shanghai Birth Registry and Shanghai Cancer Registry, with medical records from the Shanghai Health Information Network as a supplement. Macrosomia and LGA prevalence was higher in women who developed cancer than in women who did not. Having an LGA child in the first delivery was associated with a subsequently increased risk of maternal cancer (hazard ratio [HR] = 1.08, 95% confidence interval [CI] 1.04-1.11). Additionally, in the last and heaviest deliveries, there were similar associations between LGA births and maternal cancer rates (HR = 1.08, 95% CI 1.04-1.12; HR = 1.08, 95% CI 1.05-1.12, respectively). Furthermore, a substantially increased trend in the risk of maternal cancer was associated with birth weights exceeding 2500 g. Our study supports the association between LGA births and increased risks of maternal cancer, but this risk requires further investigation.

Age-dependent and sex-dependent differences in mortality from influenza-associated cardiovascular diseases among older adults in Shanghai, China: a population-based study.

OBJECTIVES: Influenza epidemics lead to substantial morbidity and mortality among older adults. This study aimed to analyse and assess the age-specific and sex-specific differences in mortality rates for cardiovascular disease (CVD) associated with influenza in older adults. DESIGN: We obtained weekly data on mortality from CVD in adults≥60 years, categorised into five age groups. We used a quasi-Poisson model and adjusted for long-term and seasonal trends and absolute humidity as confounding factors. The male-to-female ratio (M/F ratio) was an indicator for assessing sex differences. SETTING: Shanghai, China. PARTICIPANT: We analysed 440 107 CVD deaths in adults aged ≥60 years, including 44 913 cases positive for influenza and 1 927 487 outpatient visits for influenza-like illness from 2010 to 2019. MAIN OUTCOME MEASURES: Age-specific and sex-specific excess CVD mortality rates in older adults for various combinations of CVDs and influenza viruses. RESULTS: Variations were observed in the excess mortality from CVD, ischaemic heart disease (IHD) and stroke depending on the influenza types/subtypes in different age and sex categories. The ≥85 years group had the highest excess mortality rates per 100 000 persons for CVD, IHD and stroke, while influenza A (H3N2) virus accounted for the highest mortality from CVD, IHD and stroke in people aged ≥65 years. Older men had a significantly lower influenza-associated IHD mortality rate than women, with an M/F ratio of 0.77 (p<0.05). CONCLUSIONS: Excess mortality rates for CVDs associated with influenza increased with age in older adults. The risk for influenza-associated IHD mortality was significantly higher in older women than men. Our findings will help implement targeted health strategies, including the promotion of influenza vaccination and early therapeutic intervention for the older population with CVD, to curb the influenza burden effectively.

Eliciting national and subnational sets of disability weights in mainland China: Findings from the Chinese disability weight measurement study.

Background: The disability weight (DW) quantifies the severity of health states from disease sequela and is a pivotal parameter for disease burden calculation. We conducted a national and subnational DW measurement in China. Methods: In 2020-2021, we conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces targeting health workers via professional networks. We fielded questions of paired comparison (PC) and population health equivalence (PHE). The PC data were analysed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale between 0 (no loss of health) and 1 (health loss equivalent to death). Findings: We used PC responses from 468,541 respondents to estimate DWs of health states. Eight of 11 domains of health had significantly negative coefficients in the regression of the difference between Chinese and Global Burden of Disease (GBD) DWs, suggesting lower DW values for health states with mention of these domains in their lay description. We noted considerable heterogeneity within domains, however. After applying these Chinese DWs to the 2019 GBD estimates for China, total years lived with disability (YLDs) increased by 14·9% to 177 million despite lower estimates for musculoskeletal disorders, cardiovascular diseases, mental disorders, diabetes and chronic kidney disease. The lower estimates of YLDs for these conditions were more than offset by higher estimates of common, low-severity conditions. Interpretation: The differences between the GBD and Chinese DWs suggest that there might be some contextual factors influencing the valuation of health states. While the reduced estimates for mental disorders, alcohol use disorder, and dementia could hint at a culturally different valuation of these conditions in China, the much greater shifts in YLDs from low-severity conditions more likely reflects methodological difficulty to distinguish between health states that vary a little in absolute DW value but a lot in relative terms. Funding: This work was supported by the National Natural Science Foundation of China [grant number 82173626], the National Key Research and Development Program of China [grant numbers 2018YFC1315302], Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304], and Ningxia Natural Science Foundation Project [grant number 2020AAC03436].

Assessing the Diagnostic Accuracy of Physicians for Home Death Certification in Shanghai: Application of SmartVA.

Approximately 30% of deaths in Shanghai either occur at home or are not medically attended. The recorded cause of death (COD) in these cases may not be reliable. We applied the Smart Verbal Autopsy (VA) tool to assign the COD for a representative sample of home deaths certified by 16 community health centers (CHCs) from three districts in Shanghai, from December 2017 to June 2018. The results were compared with diagnoses from routine practice to ascertain the added value of using SmartVA. Overall, cause-specific mortality fraction (CSMF) accuracy improved from 0.93 (93%) to 0.96 after the application of SmartVA. A comparison with a "gold standard (GS)" diagnoses obtained from a parallel medical record review investigation found that 86.3% of the initial diagnoses made by the CHCs were assigned the correct COD, increasing to 90.5% after the application of SmartVA. We conclude that routine application of SmartVA is not indicated for general use in CHCs, although the tool did improve diagnostic accuracy for residual causes, such as other or ill-defined cancers and non-communicable diseases.

A Novel Material for High-Performance Li-O2 Battery Separator: Polyetherketone Nanofiber Membrane.

The properties of separators significantly affect the efficiency, stability, and safety of the lithium-based batteries. Therefore, the improvement of the separator material is critical. Polyetherketone (PEK) has excellent general properties, such as mechanical strength, chemical stability, and thermal stability. Thus, it is expected to be an optimal separator material. However, its low solubility-induced poor processibility makes it difficult to be used for nanoscale product manufacturing. In this work, the soluble precursor polymer is prepared by introducing a "protecting" group into monomer, and fabricated into nanofiber membrane, which can be converted into polyetherketone nanofiber membrane by a simple acid treatment. The membrane prepared by this chemical-induced crystallization method exhibits superior chemical, thermal stability, and mechanical strength. Li-O2 batteries with the fabricated membrane as separator have a high cycling stability (194 cycles at 200 mA g-1 and 500 mAh g-1 ). This work broadens the application field of PEK and provides a potential route for battery separators.

The reversing trend in suicide rates in Shanghai, China, from 2002 to 2020.

BACKGROUND: To explore changing patterns in suicides and provide suggestions for suicide prevention by reviewing all suicide deaths from 2002 to 2020 in Shanghai, China. METHODS: Suicide-death data were obtained from the Shanghai Death Surveillance System and analyzed in terms of year, sex, age group, area, suicide method, and depression diagnosis. Joinpoint regression analyses were conducted to examine time trends in suicide rates. RESULTS: The age-adjusted suicide rate was 6.15/100,000 in 2002 and 5.10/100,000 in 2020. The change in this rate was U-shaped, with a downward trend before 2009 followed by an upward trend. The rate initially decreased by 6.33% annually (95% confidence interval [95%CI]: 4.25-8.37%) but, after 2009, increased by 2.60% annually (95%CI: 1.49-3.71%). Similar trends were found for men and women, the 0-29y and 30-49y age groups, and residents of central and suburban areas, respectively. In 2020, jumping from a high place was the leading suicide method (39.54%), and 22.54% of suicide victims had a diagnosis of depression. LIMITATIONS: Suicides may be misclassified in coding (however, provided misclassification rates remain stable, this should not influence overall trends). Suicides among temporary residents were not included because of inadequate stratified population data. The finding of a higher prevalence of depression may have been impacted by a higher detection rate. CONCLUSIONS: The post-2002 decline in Shanghai suicide rates reversed in 2009, and the suicide pattern changed greatly from 2002 to 2020. With the current increasing trend in suicide rates, targeted suicide-prevention strategies featuring multi-departmental cooperation are necessary.

Association of adverse birth outcomes with in vitro fertilization after controlling infertility factors based on a singleton live birth cohort.

Infants conceived with in vitro fertilization (IVF) are exposed to underlying infertility and the IVF process. High risks of adverse birth outcomes (ABOs) were observed among these infants, including preterm birth, low birth weight, macrosomia, being large/small for gestational age (LGA/SGA). It is unclear whether the specific etiology of the rise of ABOs among IVF infants is IVF technology itself or underlying infertility. A total of 9,480 singletons conceived with IVF and 1,952,419 singletons from the general population were obtained in this study. Multivariable logistic regression model was used to assess variations in risk of ABOs according to causes of infertility. Poisson distributions were applied to calculate standardized risk ratios of IVF infants vs. general population after controlling the causes of infertility. Higher risk of preterm birth and low birth weight were observed among parents with polycystic ovary syndrome, endometriosis, uterine and semen abnormalities. Compared to the general population, after excluding the influence of infertility causes, singletons conceived with IVF were at higher risk of macrosomia (SRR = 1.28, 95% CI 1.14-1.44) and LGA (SRR = 1.25, 95% CI 1.15-1.35). The higher risk of ABOs in IVF was driven by both IVF treatments and infertility, which is important for improving IVF treatments and the managing pregnancies and child development.

Are cause of death data for Shanghai fit for purpose? A retrospective study of medical records.

OBJECTIVES: To assess the quality of cause of death reporting in Shanghai for both hospital and home deaths. DESIGN AND SETTING: Medical records review (MRR) to independently establish a reference data set against which to compare original and adjusted diagnoses from a sample of three tertiary hospitals, one secondary level hospital and nine community health centres in Shanghai. PARTICIPANTS: 1757 medical records (61% males, 39% females) of deaths that occurred in these sample sites in 2017 were reviewed using established diagnostic standards. INTERVENTIONS: None. PRIMARY OUTCOME: Original underlying cause of death (UCOD) from medical facilities. SECONDARY OUTCOME: Routine UCOD assigned from the Shanghai Civil Registration and Vital Statistics (CRVS) system and MRR UCODs from MRR. RESULTS: The original UCODs as assigned by doctors in the study facilities were of relatively low quality, reduced to 31% of deaths assigned to garbage codes, reduced to 2.3% following data quality and follow back procedures routinely applied by the Shanghai CRVS system. The original UCOD had lower chance-corrected concordance and cause-specific mortality fraction accuracy of 0.57 (0.44, 0.70) and 0.66, respectively, compared with 0.75 (0.66, 0.85) and 0.96, respectively, after routine data checking procedures had been applied. CONCLUSIONS: Training in correct death certification for clinical doctors, especially tertiary hospital doctors, is essential to improve UCOD quality in Shanghai. A routine quality control system should be established to actively track diagnostic performance and provide feedback to individual doctors or facilities as needed.

No Association Was Found Between Mild Iodine Deficiency During Pregnancy and Pregnancy Outcomes: a Follow-up Study Based on a Birth Registry.

BACKGROUND: Severe iodine deficiency during gestation is associated with adverse pregnancy outcomes; however, the impact of mild-to-moderate iodine deficiency, though prevalent in pregnancy, remains unclear. METHODS: We extracted follow-up data for 7435 pregnant women from a national iodine deficiency disorders monitoring program from 2016 to 2018 and a mother-child cohort study in 2017 based on a birth registry in Shanghai. Birth outcomes were collected from the registry. Spot urine and household salt samples were collected for iodine testing. Single-factor analysis and logistic regression were used to evaluate the association between maternal iodine status and pregnancy outcomes. RESULTS: The median urine iodine level in pregnant women was 137.5 µg/L (interquartile range 82.4-211.5), suggesting mild deficiency according to WHO standards. The incidence of pregnancy termination, preterm birth, congenital malformations, low birth weight, and cesarean section was 3.2%, 4.3%, 1.4%, 2.7%, and 45.2% in the mildly iodine-deficient group and 3.4%, 4.5%, 1.4%, 2.7%, and 44.5% in the normal group, respectively. After adjusting for maternal age and education, trimesters, and preterm birth rate in the general population, the odds ratios for any outcome did not differ significantly between the two groups. CONCLUSION: The present study suggests that mild maternal iodine deficiency is not associated with adverse pregnancy outcomes.

Tolerance to Glucose and Lipid High Metabolic Reactions After Burns in an Obese Rat Model.

The goal of this study was to determine what effect obese body weight and a burn injury can have on the metabolism of glucose and lipids in rats. We used a 3 * 3 factorial model design to provide basic glucose and lipid metabolic data characterizing the interaction between different weight and burn injury groups. Two hundred Sprague Dawley rats were categorized into three weight groups (normal, overweight, obese) and then further divided into control, second-degree, and third-degree burn groups. Our model compared interactions between weight and burn injury factors according to the above groups. Blood glucose and lipid metabolism indicators were monitored on the 1st, 3rd, 7th, and 14th days after burn injury occurred, and burned skin and blood samples were collected for testing. Compared with the normal weight group, the overweight group's fast blood glucose, fast insulin, and homeostasis model assessment of insulin resistance were higher (P < .05), and FBG in the obese group was higher than the normal weight group (P < .05). Burn injuries combined with obese body weight had an interactive effect on fast blood glucose, fast insulin, and homeostasis model assessment of insulin resistance after burn injury (P < .05). Burn injury combined with obese body weight had an interaction on low-density lipoprotein cholesterol on the 3rd day after burn injury (P < .05). Burn injury combined with obese weight had no interaction on triglyceride, total cholesterol, and high-density lipoprotein cholesterol (P > .05). Rats in the overweight and obese weight groups were observed to develop an adaptation and tolerance to a higher metabolic rate after burn injuries occurred.

Characteristic and Introspection of Road Traffic Injuries in China from 2012 to 2017.

BACKGROUND: To analyze whether the area differences of RTIs (road traffic injuries, RTIs) caused by unequal development in China, provide suggestions for the prevention of the RTIs. METHODS: The data of RTIs in China was collected from the authoritative official website and yearbook of China. RESULTS: Total RTIs in the East was the highest (RTIs frequency: 591789; injured people: 600611; death toll: 168885; economic loss: 27.22 billion RMB), followed by the Center (RTIs frequency: 321807; injured people: 352769; death toll: 91966; economic loss: 23.90 billion RMB) and the lowest in the West (RTIs frequency: 289482; injured people: 332517; death toll: 101095; economic loss: 16.35 billion RMB). The multivariate linear correlation and regression showed that the characteristic of RTIs was highly related with GDP (r=0.99, P < 0.001). CONCLUSION: The economically developed areas had a large amount of traffic damages. The government should focus on preventing high RTIs in the East and high death tolls in the West.

Development of influenza-associated disease burden pyramid in Shanghai, China, 2010-2017: a Bayesian modelling study.

OBJECTIVES: Negative estimates can be produced when statistical modelling techniques are applied to estimate morbidity and mortality attributable to influenza. Based on the prior knowledge that influenza viruses are hazardous pathogens and have adverse health outcomes of respiratory and circulatory disease (R&C), we developed an improved model incorporating Bayes' theorem to estimate the disease burden of influenza in Shanghai, China, from 2010 to 2017. DESIGN: A modelling study using aggregated data from administrative systems on weekly R&C mortality and hospitalisation, influenza surveillance and meteorological data. We constrained the regression coefficients for influenza activity to be positive by truncating the prior distributions at zero. SETTING: Shanghai, China. PARTICIPANTS: People registered with R&C deaths (450 298) and hospitalisations (2621 787, from 1 July 2013), and with influenza-like illness (ILI) outpatient visits (342 149) between 4 January 2010 and 31 December 2017. PRIMARY OUTCOME MEASURES: Influenza-associated disease burden (mortality, hospitalisation and outpatient visit rates) and clinical severity (outpatient-mortality, outpatient-hospitalisation and hospitalisation-mortality risks). RESULTS: Influenza was associated with an annual average of 15.49 (95% credibility interval (CrI) 9.06-22.06) excess R&C deaths, 100.65 (95% CrI 48.79-156.78) excess R&C hospitalisations and 914.95 (95% CrI 798.51-1023.66) excess ILI outpatient visits per 100 000 population in Shanghai. 97.23% and 80.24% excess R&C deaths and hospitalisations occurred in people aged ≥65 years. More than half of excess morbidity and mortality were associated with influenza A(H3N2) virus, and its severities were 1.65-fold to 3.54-fold and 1.47-fold to 2.16-fold higher than that for influenza A(H1N1) and B viruses, respectively. CONCLUSIONS: The proposed Bayesian approach with reasonable prior information improved estimates of influenza-associated disease burden. Influenza A(H3N2) virus was generally associated with higher morbidity and mortality, and was relatively more severe compared with influenza A(H1N1) and B viruses. Targeted influenza prevention and control strategies for the elderly in Shanghai may substantially reduce the disease burden.