Anterior peri-sacroiliac joint osteotomy in the treatment of malunion and nonunion of complex pelvic ring fracture: techniques and preliminary results.

PURPOSE: To introduce anterior peri-sacroiliac joint osteotomy (APSJO) through the lateral-rectus approach (LRA) for treating pelvic fracture malunion and nonunion, and to evaluate the safety, feasibility, and potential effectiveness. METHODS: Data of 15 patients with pelvic fracture malunion and nonunion who underwent treatment by APSJO were selected and analyzed. The reduction quality was assessed using the Mears and Velyvis criteria, while the pre-operative and post-operative function was revealed by the Majeed scoring system. The British Medical Research Council (BMRC) grading system was recruited for the evaluation of lumbosacral plexus function. RESULTS: The average operative duration was 264.00 ± 86.75 min, while the intra-operative blood loss was 2000 (600, 3000) mL. Anatomical reduction was complete in three cases, satisfactory in ten cases, and unsatisfactory in two cases. Among the seven patients with lumbosacral plexus injury, the pre-operative Majeed grades were good in two cases, fair in two cases, and poor in three cases, while the post-operative Majeed grades were excellent in three cases, good in three cases, and fair in one case. Muscle strength recovered to M5 in two cases, M4 in three cases, and showed no recovery in two cases. The pre-operative Majeed grades were good in five cases, fair in two cases, and poor in one case of the series without lumbosacral plexus injury, while the post-operative Majeed grades were excellent in seven cases and good in one case. CONCLUSION: APSJO through LRA may be a feasible strategy for treating pelvic fracture malunion and nonunion with promising application.

Differential effects of size-specific particulate matter on frailty transitions among middle-aged and older adults in China: findings from the China Health and Retirement Longitudinal Study (CHARLS), 2015-2018.

BACKGROUND: This study aimed to assess the long-term effects of size-specific particulate matter (PM) on frailty transitions in middle-aged and older Chinese adults. METHODS: We included 13 910 participants ≥45 y of age from the China Health and Retirement Longitudinal Study (CHARLS) for 2015 and 2018 who were classified into three categories in 2015 according to their frailty states: robust, prefrail and frail. Air quality data were obtained from the National Urban Air Quality Real-time Publishing Platform. A two-level logistic regression model was used to examine the association between concentrations of PM and frailty transitions. RESULTS: At baseline, the total number of robust, prefrail and frail participants were 7516 (54.0%), 4324 (31.1%) and 2070 (14.9%), respectively. Significant associations were found between PM concentrations and frailty transitions. For each 10 µg/m3 increase in the 3-y averaged 2.5-µm PM (PM2.5) concentrations, the risk of worsening in frailty increased in robust (odds ratio [OR] 1.06 [95% confidence interval {CI} 1.01 to 1.12]) and prefrail (OR 1.07 [95% CI 1.01 to 1.13]) participants, while the probability of improvement in frailty in prefrail (OR 0.91 [95% CI 0.84 to 0.98]) participants decreased. In addition, the associations of PM10 and coarse fraction of PM with frailty transitions showed similar patterns. CONCLUSIONS: Long-term exposure to PM was associated with higher risks of worsening and lower risks of improvement in frailty among middle-aged and older adults in China.

A dataset of a proxy variable for the poultry trade flows in China.

Understanding the intercity poultry trading network is crucial for assessing the risk of avian influenza prevalence. Unfortunately, the poultry trading network in China has rarely been described. Here, with a modified radiation model, we obtain values for a proxy variable for poultry trade flows among 318 prefecture-level cities in China in 2015 utilizing the product capacity and demand quantity of poultry of the cities. The results are validated by comparing the proxy variable values with the trade volumes investigated in the literature, and it is found that the modified radiation model can accurately predict the main poultry trade flows among cities. This is the first dataset on China's poultry trade pattern, and it can be used to analyze the production and consumption structure of poultry in prefecture-level cities within China. The dataset can be a tool for avian influenza epidemic risk assessment as well as a basis to develop prevention and control measures during an epidemic.

Spatial-temporal heterogeneity and determinants of HIV prevalence in the Mano River Union countries.

BACKGROUND: Utilizing population-based survey data in epidemiological research with a spatial perspective can integrate valuable context into the dynamics of HIV prevalence in West Africa. However, the situation in the Mano River Union (MRU) countries is largely unknown. This research aims to perform an ecological study to determine the HIV prevalence patterns in MRU. METHODS: We analyzed Demographic and Health Survey (DHS) and AIDS Indicator Survey (AIS) data on HIV prevalence in MRU from 2005 to 2020. We examined the country-specific, regional-specific and sex-specific ratios of respondents to profile the spatial-temporal heterogeneity of HIV prevalence and determine HIV hot spots. We employed Geodetector to measure the spatial stratified heterogeneity (SSH) of HIV prevalence for adult women and men. We assessed the comprehensive correct knowledge (CCK) about HIV/AIDS and HIV testing uptake by employing the Least Absolute Shrinkage and Selection Operator (LASSO) regression to predict which combinations of CCKs can scale up the ratio of HIV testing uptake with sex-specific needs. RESULTS: In our analysis, we leveraged data for 158,408 respondents from 11 surveys in the MRU. From 2005-2015, Cote d'Ivoire was the hot spot for HIV prevalence with a Gi_Bin score of 3, Z-Score 8.0-10.1 and P < 0.001. From 2016 to 2020, Guinea and Sierra Leone were hot spots for HIV prevalence with a Gi_Bin score of 2, Z-Score of 3.17 and P < 0.01. The SSH confirmed the significant differences in HIV prevalence at the national level strata, with a higher level for Cote d'Ivoire compared to other countries in both sexes with q-values of 0.61 and 0.40, respectively. Our LASSO model predicted different combinations of CCKs with sex-specific needs to improve HIV testing uptake. CONCLUSIONS: The spatial distribution of HIV prevalence in the MRU is skewed and the CCK about HIV/AIDS and HIV testing uptake are far below the threshold target set by UNAIDS for ending the epidemic in the sub-region. Geodetector detected statistically significant SSH within and between countries in the MRU. Our LASSO model predicted that different emphases should be implemented when popularizing the CCK about HIV/AIDS for adult women and men.

Characterization of influenza seasonality in China, 2010-2018: Implications for seasonal influenza vaccination timing.

BACKGROUND: Optimizing the timing of influenza vaccination based on regional temporal seasonal influenza illness patterns may make seasonal influenza vaccination more effective in China. METHODS: We obtained provincial weekly influenza surveillance data for 30 of 31 provinces in mainland China from the Chinese Center for Disease Control and Prevention for the years 2010-2018. Influenza epidemiological regions were constructed by clustering analysis. For each region, we calculated onset date, end date, and duration of seasonal influenza epidemics by the modified mean threshold method. To help identify initial vaccination target populations, we acquired weekly influenza surveillance data for four age groups (0-4, 5-18, 19-59, and ≥60 years) in each region and in 171 cities of wide-ranging size. We used linear regression analyses to explore the association of epidemic onset dates by age group, city, and epidemiological region and provide evidence for initial target populations for seasonal influenza vaccination. RESULTS: We determined that northern, mid, southwestern, southeast regions of mainland China have distinct seasonal influenza epidemic patterns. We found significant regional, temporal, and spatial heterogeneity of seasonal influenza epidemics. There were significant differences by age group and city size in the interval between epidemic onset in the city or age group and regional spread (epidemic lead time), with longer epidemic lead times for 5- to 18-year-old children and larger cities. CONCLUSIONS: Knowledge of influenza epidemic characteristics may help optimize local influenza vaccination timing and identify initial target groups for seasonal influenza vaccination in mainland China. Similar analyses may help inform seasonal influenza vaccination strategies in other regions and countries.

Simulation of average monthly ozone exposure concentrations in China: A temporal and spatial estimation method.

BACKGROUND: Ozone has adverse effects on human health, it is necessary to obtain the refined ozone exposure concentration. At present, most of existing ozone exposure research is based on ground air quality monitoring station (MS) which gather urban area information only. It is diffcult to estimate the ozone in the areas where MSs are scarce. OBJECTIVE: By combining accurate but uneven data of outdoor ozone exposure concentrations based on MSs and unbiased coverage data based on RS in China, we can improve the accuracy of simulation of average monthly ozone exposure concentrations in monitor-free area. Since ozone concentrations are usually low at night, ozone exposure is assessed during the day (e.g., 10:00-18:00). METHODS: We proposed a space-time geostatistical kriging interpolation based on the composite space/time mean trend model (CSTM) to predict ozone exposure in mainland China, having obtained a refined ozone exposure concentration interpolation map from an MS. We verified the accuracy of the interpolation results and remote sensing (RS) data, while simultaneously determining the distance threshold (according to the data accuracy) to improve the accuracy of the hybrid map. RESULTS: We used a refined smoothing filter to reduce the influence of spatial and seasonal trends on ozone concentration. We found a cutoff separation distance of 175 km at which the two data showed an equal estimation accuracy, and the estimation result was fused with RS data through the distance threshold. Finally, The multi-source data with the best accuracy were fused to obtain the refined map. In China, ozone exposure concentration mainly gathers in the northern and eastern regions as well as part of the central mainland. CONCLUSIONS: RS data can be used to characterize ground ozone exposure concentrations when 24th-layer data and MS data for monitoring ozone exposure concentrations are combined to estimate temporal and spatial ozone exposure in China. Ozone exposure in China can be explored further to provide suggestions for human health and regional economic development.

Seasonal association between viral causes of hospitalised acute lower respiratory infections and meteorological factors in China: a retrospective study.

BACKGROUND: Acute lower respiratory infections (ALRIs) caused by respiratory viruses are common and persistent infectious diseases worldwide and in China, which have pronounced seasonal patterns. Meteorological factors have important roles in the seasonality of some major viruses, especially respiratory syncytial virus (RSV) and influenza virus. Our aim was to identify the dominant meteorological factors and to model their effects on common respiratory viruses in different regions of China. METHODS: We analysed monthly virus data on patients hospitalised with ALRI from 81 sentinel hospitals in 22 provinces in mainland China from Jan 1, 2009, to Sept 30, 2013. We considered seven common respiratory viruses: RSV, influenza virus, human parainfluenza virus, adenovirus, human metapneumovirus, human bocavirus, and human coronavirus. Meteorological data of the same period were used to analyse relationships between virus seasonality and seven meteorological factors according to region (southern vs northern China). The geographical detector method was used to quantify the explanatory power of each meteorological factor, individually and interacting in pairs, on the respiratory viruses. FINDINGS: 28 369 hospitalised patients with ALRI were tested, 10 387 (36·6%) of whom were positive for at least one virus, including RSV (4091 [32·0%] patients), influenza virus (2665 [20·8%]), human parainfluenza virus (2185 [17·1%]), adenovirus (1478 [11·6%]), human bocavirus (1120 [8·8%]), human coronavirus (637 [5·0%]), and human metapneumovirus (615 [4·8%]). RSV and influenza virus had annual peaks in the north and biannual peaks in the south. Human parainfluenza virus and human bocavirus had higher positive rates in the spring-summer months. Human metapneumovirus had an annual peak in winter-spring, especially in the north. Adenovirus and human coronavirus exhibited no clear annual seasonality. Temperature, atmospheric pressure, vapour pressure, and rainfall had most explanatory power on most respiratory viruses in each region. Relative humidity was only dominant in the north, but had no significant explanatory power for most viruses in the south. Hours of sunlight had significant explanatory power for RSV and influenza virus in the north, and for most viruses in the south. Wind speed was the only factor with significant explanatory power for human coronavirus in the south. For all viruses, interactions between any two of the paired factors resulted in enhanced explanatory power, either bivariately or non-linearly. INTERPRETATION: Spatiotemporal heterogeneity was detected for most viruses in this study, and interactions between pairs of meteorological factors were found to enhance their influence on virus variation. These findings might be helpful to guide government planning, such as public health interventions, infection control practice, and timing of passive immunoprophylaxis, and might facilitate the development of future vaccine strategies. FUNDING: National Natural Science Foundation of China, the Ministry of Science and Technology of China, and the Technology Major Project of China. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Spatial distribution of esophageal cancer mortality in China: a machine learning approach.

BACKGROUND: Esophageal cancer (EC) is one of the most common cancers, causing many people to die every year worldwide. Accurate estimations of the spatial distribution of EC are essential for effective cancer prevention. METHODS: EC mortality surveillance data covering 964 surveyed counties in China in 2014 and three classes of auxiliary data, including physical condition, living habits and living environment data, were collected. Genetic programming (GP), a hierarchical Bayesian model and sandwich estimation were used to estimate the spatial distribution of female EC mortality. Finally, we evaluated the accuracy of the three mapping methods. RESULTS: The results show that compared with the root square mean error (RMSE) of the hierarchical Bayesian model at 6.546 and the sandwich estimation at 7.611, the RMSE of GP is the lowest at 5.894. According to the distribution estimated by GP, the mortality of female EC was low in some regions of Northeast China, Northwest China and southern China; in some regions downstream of the Yellow River Basin, north of the Yangtze River in the Yangtze River Basin and in Southwest China, the mortality rate was relatively high. CONCLUSIONS: This paper provides an accurate map of female EC mortality in China. A series of targeted preventive measures can be proposed based on the spatial disparities displayed on the map.

Evaluating an intervention for neural tube defects in coal mining cites in China: a temporal and spatial analysis.

BACKGROUND: Neural tube defects (NTDs) are congenital birth defects of the central nervous system that affect 0.5-2 per 1000 pregnancies worldwide. Therefore effective interventions for birth defects, especially NTDs, are very important. METHODS: Yuanping City is a coal mining city in Shanxi Province, China, with a high incidence of NTDs. This study evaluates the effects of NTD interventions in this city after adjusting for covariates that characterize the native environment. The number of NTD cases and births for the 18 towns in Yuanping City from 2007 to 2014 were included in the study. A shared-component zero-inflated Poisson regression was applied to analyse the temporal-spatial variance among the incidence rates of NTDs in Yuanping City before and after the interventions. RESULTS: The results showed that existing interventions to mitigate birth defects, such as folic acid supplementation, reduced the incidence of NTDs by 53.5% in coal mining areas in Yuanping City. However, the NTD risk in areas near coal mines, especially unrestored coal mines, was still high, even after the intervention. CONCLUSIONS: The government should focus on health hazards related to mining and agricultural production and should provide education and resources to reduce environmental exposure. Reducing environmental risks should be regarded as an early intervention strategy to mitigate birth defects.

Temporal and spatial distribution trends of human brucellosis in Liaoning Province, China.

Brucellosis is a natural epidemic zoonotic disease. Liaoning province, north-east of China, has been among the top 10 provinces with highest brucellosis incidence. In this study, the spatial and temporal distribution of brucellosis in Liaoning Province from 2006 through 2017 was analysed using the Bayesian theory of space-time modelling. The study found that in Liaoning Province, (a) all regions of the entire study area were stable counties; (b) the risk of brucellosis declined slowly with time without an obvious trend; (c) the declining trend of disease risk in three sub-hot-spot counties was faster than the overall trend, whereas in other counties, the trend was similar to the overall trend. Furthermore, the time and spatial trends of brucellosis incidence in Liaoning Province were calculated and analysed. These results may provide a theoretical and scientific basis for the public health department to develop targeted effective prevention and control measures for the disease.

Pollution zone identification research during ozone pollution processes.

Identifying an ozone pollution zone during the pollution processes is significant for ozone pollution management and environmental health risk assessment. However, few studies have focused on ozone pollution zone identification during pollution processes. A spatial-temporal clustering framework for identifying pollution zones during ozone pollution processes was initially proposed in this study, and an ozone pollution process in China in May 2017 was selected as a case. The results showed that the framework can help selecting one more accurate method to identify the pollution zone according to the pollution characteristics of air pollution process. In addition, different ozone pollution zone identification methods work well in different scenarios: The self-organizing map (SOM) method was suitable for identifying the zone with the duration of pollution between 24 and 48 h, the image fusion based on wavelet transform (IFbWT) method for the zone with the duration of pollution over 48 h and the Apriori method for the zone with obvious boundaries between high-value and low-value ozone concentrations. The proposed procedure can also be applied to identify the pollution zone of the pollution process of other pollutants.

Early forecasting of the potential risk zones of COVID-19 in China's megacities.

Recently, the coronavirus disease 2019 (COVID-19) has become a worldwide public health threat. Early and quick identification of the potential risk zones of COVID-19 infection is increasingly vital for the megacities implementing targeted infection prevention and control measures. In this study, the communities with confirmed cases during January 21-February 27 were collected and considered as the specific epidemic data for Beijing, Guangzhou, and Shenzhen. We evaluated the spatiotemporal variations of the epidemics before utilizing the ecological niche models (ENM) to assemble the epidemic data and nine socioeconomic variables for identifying the potential risk zones of this infection in these megacities. Three megacities were differentiated by the spatial patterns and quantities of infected communities, average cases per community, the percentages of imported cases, as well as the potential risks, although their COVID-19 infection situations have been preliminarily contained to date. With higher risks that were predominated by various influencing factors in each megacity, the potential risk zones coverd about 75% to 100% of currently infected communities. Our results demonstrate that the ENM method was capable of being employed as an early forecasting tool for identifying the potential COVID-19 infection risk zones on a fine scale. We suggest that local hygienic authorities should keep their eyes on the epidemic in each megacity for sufficiently implementing and adjusting their interventions in the zones with more residents or probably crowded places. This study would provide useful clues for relevant hygienic departments making quick responses to increasingly severe epidemics in similar megacities in the world.

Seroprevalence of H7N9 infection among humans: A systematic review and meta-analysis.

In spring 2013, a novel avian-origin influenza A (H7N9) virus emerged in mainland China. The burden of H7N9 infection was estimated based on systematic review and meta-analysis. The systematic search for available literature was conducted using Chinese and English databases. We calculated the pooled seroprevalence of H7N9 infection and its 95% confidence interval by using Freeman-Tukey double arcsine transformation. Out of 16 890 records found using Chinese and English databases, 54 articles were included in the meta-analysis. These included studies of a total of 64 107 individuals. The pooled seroprevalence of H7N9 infection among humans was 0.122% (95% CI: 0.023, 0.275). In high-risk populations, the highest pooled seroprevalence was observed among close contacts (1.075%, 95% CI: 0.000, 4.357). The seroprevalence among general population was (0.077%, 95% CI: 0.011, 0.180). Our study discovered that asymptomatic infection of H7N9 virus did occur, even if the seroprevalence among humans was low.

Application of sandwich spatial estimation method in cancer mapping: A case study for breast cancer mortality in the Chinese mainland, 2005.

High-accuracy spatial distribution estimation is crucial for cancer prevention and control. Due to their complicated pathogenic factors, the distributions of many cancers' mortalities appear blocky, and spatial heterogeneity is common. However, most of the commonly used cancer mapping methods are based on spatial autocorrelation theory. Sandwich estimation is a new method based on spatial heterogeneity theory. A modified sandwich estimation method suitable for the estimation of cancer mortality distribution is proposed in this study. The variances of cancer mortality data are used to fuse sandwich estimation results from various auxiliary variables, the feasibility of which in estimating cancer mortality distributions is explained theoretically. The breast cancer (BC) mortality of the Chinese mainland in 2005 was taken as a case, and the accuracy of the modified sandwich estimation method was compared with that of the Hierarchical Bayesian (HB), the Co-Kriging (CK) and the Ordinary Kriging (OK) methods. The accuracy of the modified sandwich estimation method was better than the HB, the CK and the OK methods, and the estimation result from the modified sandwich estimation method was more likely to be acceptable. Therefore, this study represents an attempt to apply the sandwich estimation method to the estimation of cancer mortality distributions with strong spatial heterogeneity, which holds great potential for further application.

Spatial Characteristics of Heavy Metals in Street Dust of Coal Railway Transportation Hubs: A Case Study in Yuanping, China.

Coal is a vital basic energy source in China, and rail serving is its major mode of transportation. Heavy metals in street dust surrounding the coal railway do harm to the environment and pose a potential risk to human health. This paper aims to identify the effects of coal transportation hubs on heavy metals in street dust. The geoaccumulation index and ecological risk index were used to assess the contamination levels of the following elements in Yuanping, Shanxi: arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), nickel (Ni), lead (Pb), and zinc (Zn). The levels of contamination of these heavy metals in soils were compared to those in street dust, and the difference between the railway's and mining's impacts on dust's heavy-metal concentrations was explored. The results indicated that Cr and Pb in street dust were mainly affected by coal railway transportation, and the interaction effect of coal railway transportation and mining was greater than either of them alone. A potential control and prevention zone for Cr and Pb extending 1 km to both sides of the railway was identified. This work proves that coal railway transportation has certain effect on heavy metals in street dust and provides a scientific approach for future environmental impact assessments of coal transportation via railway.

Predicting the potential risk area of illegal vaccine trade in China.

Since the disclosure of the "Illegal vaccine operation series case in Jinan, Shandong" in March, 2016, this issue has attracted a great deal of attention and has led to public concerns about the safety and efficacy of the vaccines involved in this case. The main purpose of this paper is to scientifically and scrupulously predict the possible geographic distribution of illegal vaccines in China, and provide a foundation to guide future governmental policies and actions. A species distribution model was used because of the advantages of using presence/pseudo-absence or presence-only data, and it performs well with incomplete species distribution data. A series of socioeconomic variables were used to simulate habitat suitability distribution. Maxent (Maximum Entropy Model) and GARP (Genetic Algorithm for Rule set Production) were used to predict the risks of illegal vaccines in China, and define the spatial distribution and significant factors of the area at risk from illegal vaccines. Jackknife tests were used to evaluate the relative importance of socioeconomic variables. It was found that: (1) Shandong, Hebei, Henan, Jiangsu and Anhui are the main high-risk areas impacted by the vaccines involved in Jinan case. (2) Population density and industrial structure are the main socioeconomic factors affecting areas which may be at risk from illegal vaccines.

Spatial and temporal patterns of nasopharyngeal carcinoma mortality in China, 1973-2005.

We fitted generalized linear models using data from three national retrospective surveys on cause of death in China to explore the spatial and temporal patterns of nasopharyngeal carcinoma (NPC) mortality over the period 1973 to 2005. The results suggest that there was a significant decrease in NPC mortality in China over time (p < 0.0001), the mortality rate ratio (RR) for the two later time periods were 0.59 (95% CI: 0.55-0.64) for 1990-1992 and 0.42 (95% CI: 0.39-0.45) for 2004-2005 compared to that of 1973-1975. Residents living in the South China areas have an elevated risk of mortality from NPC compared to those living in North China across all three time periods, with the RR being 4.96 (95% CI: 4.31-5.70) in 1973-1975, 12.83 (95% CI: 10.73-15.34) in 1990-1992 and 15.20 (95% CI: 12.34-18.72) in 2004-2005. Although NPC mortality in most areas of China has reduced to very low levels, the widening geographical disparities in NPC mortality are still noteworthy. It may be necessary to target public health policies to address the widening geographical disparities in NPC mortality.

A new method for assessing the risk of infectious disease outbreak.

Over the past few years, emergent threats posed by infectious diseases and bioterrorism have become public health concerns that have increased the need for prompt disease outbreak warnings. In most of the existing disease surveillance systems, disease outbreak risk is assessed by the detection of disease outbreaks. However, this is a retrospective approach that impacts the timeliness of the warning. Some disease surveillance systems can predict the probabilities of infectious disease outbreaks in advance by determining the relationship between a disease outbreak and the risk factors. However, this process depends on the availability of risk factor data. In this article, we propose a Bayesian belief network (BBN) method to assess disease outbreak risks at different spatial scales based on cases or virus detection rates. Our experimental results show that this method is more accurate than traditional methods and can make uncertainty estimates, even when some data are unavailable.

Trends in geographical disparities for cervical cancer mortality in China from 1973 to 2013: a subnational spatio-temporal study.

OBJECTIVE: This study was designed to explore the time trends in geographical variations of cervical cancer mortality in mainland China over the period 1973 to 2013, to provide subnational spatio-temporal patterns for targeted promotion of human papillomavirus vaccine in China. METHODS: Data were extracted from three national retrospective death surveys and cancer registry. The rate ratio (RR) was estimated for the aggregated data for seven geographical regions using generalized linear models to evaluate time trends in geographical disparities of cervical cancer mortality. RESULTS: There was a significant decrease in cervical cancer mortality in China from 1973-1975 to 2004-2005, but leveled off thereafter to 2011-2013. Compared to the period 1973-1975 the RR for the three last time periods were 0.33 [95% confidence interval (95% CI): 0.30-0.37] for 1990-1992, 0.21 (95% CI: 0.19-0.24) for 2004-2005 and 0.24 (95% CI: 0.22-0.26) for 2011-2013. Females living in the Northwest China and Central China have a high risk of mortality from cervical cancer compared to the nationwide, with the RR being 2.09 (95% CI: 1.83-2.38) and 1.26 (95% CI: 1.11-1.44) respectively, while the RRs for South China, Northeast China and Southwest China were below 1.00, indicating the lower death risk. Despite the mortality rate had increased slightly from 2004 to 2013, there was an encouraging sign that the geographical disparities in cervical cancer mortality had gradually narrowed over time across China. CONCLUSIONS: Although cervical cancer mortality in China has reduced to very low levels, the high risk of cervical cancer in Northwest China and Central China is still noteworthy. Public health policies including the promotion of vaccine should be targeted to further reduction of geographical disparities in cervical cancer mortality.