Prevalence of atrial fibrillation in China and its risk factors / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the prevalence of atrial fibrillation (AF) and the relation with its risk factors in China.</p><p><b>METHODS</b>A total of 19 363 participants (8635 males and 10 728 females) aged ⋝35 years in geographically dispersed urban and rural regions of China were included in this cross-sectional survey. All participants received questionnaire, physical and blood examination. Echocardiography were performed for AF patients found in the survey.</p><p><b>RESULTS</b>Of the 19 363 participants, 199 were diagnosed with AF. The estimated age-standardized prevalence of AF was 0.78% in men and 0.76% in women. The prevalence of AF in participants aged <60 years was 0.41% in men and 0.43% in women, and was 1.83% in both men and women aged ⋝60 years. About 19.0% of males and 30.9% of females with AF were diagnosed with valve disease. Age- and sex-adjusted multivariable logistic regression analysis revealed that myocardial infarction, left ventricular hypertrophy (LVH), obesity, and alcohol consumption were associated with a increased risk of AF(P<0.05).</p><p><b>CONCLUSION</b>The age standardized prevalence of AF is 0.77% in the participants enrolled in the present study. The number of AF cases aged ⋝35 years is 5.26 million according to 2010 Chinese Census. Most risk factors for AF, identified mainly in Western countries, are also detected in China.</p>

Body mass index and prognosis in patients with systolic heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>In individuals without cardiovascular disease, elevated body mass index (BMI) is associated with an increased risk of death. However, in patients with certain chronic diseases, including heart failure, low BMI has been associated with increased mortality. We investigated the association between BMI and prognosis in patients with systolic HF.</p><p><b>METHOD</b>Follow-up was made on 540 patients (mean age 58.53 years, 84.2% men) with systolic HF (LVEF < or = 45%) and association between BMI and adverse cardiac events was analyzed.</p><p><b>RESULTS</b>During a median follow-up of 24 months, 92 patients died including 87 cases of cardiac death and 92 patients were rehospitalized. Compared with patients with BMI higher than 28.0 kg/m(2), patients in lower BMI categories (BMI < or = 18.5 kg/m(2) and > or = 18.5 kg/m(2) < 24.0 kg/m(2)) had a graded increase in the all cause death rate [5.44 (1.78 - 16.66), 4.30 (1.71 - 10.82)], cardiac death rate [OR(95%CI): 5.42 (1.77 - 16.59), 4.00 (1.59 - 10.10)], HF death rate [8.94 (2.37 - 33.74), 4.97 (1.52 - 16.20)] and MACE rate [2.10 (1.09 - 4.07), 1.79 (1.14 - 2.82)]. After adjustment for age, gender, LVEF and NYHA grade using cox regression analysis, BMI categories still significantly associated with all cause death rate (OR = 0.77, P < 0.05), cardiac death rate (OR = 0.78, P < 0.05) and HF death rate (OR = 0.79, P < 0.05).</p><p><b>CONCLUSION</b>In patients with systolic heart failure, lower BMI was an independent predictor of increased all cause death rate, cardiac death rate and HF death rate.</p>

Profile and associations of carotid femoral pulse wave velocity in a community-based Beijing population of middle and old age / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the profile and related factors of carotid femoral pulse wave velocity (CFPWV) in a community-based Beijing population of middle and old age.</p><p><b>METHODS</b>A total of 1519 residents aged 44 - 79 years old from Shijingshan district, Beijing, were recruited for the cardiovascular risk factor survey and CFPWV measurements. One way ANOVA, pearson correlation and partial correlation, stepwise multi-linear regression were used for the data analysis.</p><p><b>RESULTS</b>(1) The age-adjusted mean value of CFPWV was significantly higher in men than that in women (11.4 vs. 11.1 m/s, P = 0.007). CFPWV increased significantly with age both for men and women (all P < 0.01). (2) After adjusting for age and gender, CFPWV was significantly higher in people with hypertension, diabetes and higher heart rate (> 70 beats/min) than people without these factors (P < 0.01). (3) CFPWV significantly correlated with age, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate (correlation coefficient ranged from 0.12 - 0.46, all P < 0.01). In female, CFPWV was positively correlated with total cholesterol and triglycerides (correlation coefficient 0.11 and 0.13, all P < 0.01). Multi-linear regression analysis showed age, gender, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate were independent predictors of CFPWV.</p><p><b>CONCLUSION</b>In this middle and old age Chinese population, age, sex, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate but not HDL-cholesterol and body mass index were associated with CFPWV.</p>

A cohort study on parental history and risk factors of stroke in Chinese population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the relationship between parental history and the incidence of stroke in Chinese populations.</p><p><b>METHODS</b>A total of 15,131 individuals (7015 men and 8116 women, aged from 35 to 59 years) in China were enrolled and followed up from 1992 to 2005. Information on the parental history of stroke of the participants was collected at baseline study under face to face interview. Individuals were divided into three groups according to their parental history of hypertension: those with no parental history of hypertension (Group 1), those with only one parent having the history of hypertension (Group 2) and those with both parents having the history of hypertension (Group 3). The hazard ratio and its 95% confidence interval were calculated using the Cox proportional hazard model.</p><p><b>RESULTS</b>There were 370 stroke events during 163 858 person-years of observation. After adjusting for age and sex, the hazard ratioon stroke for group 1, group 2 and group 3 were 1.00, 1.74 (1.33-2.29), 3.61 (1.86-7.01), respectively. After adjusting for age, sex, smoking, drinking, serum total cholesterol (TC), high density lipid cholesterol (HDL-C), fasting glucose, body mass index (BMI) and systolic blood pressure (SBP) in the model, the hazard ratio for stroke of those three groups were 1.00, 1.34 (1.02-1.77), 2.50 (1.29-4.87), respectively.</p><p><b>CONCLUSION</b>Individuals with parental history of stroke had a higher risk of stroke, and this was especially true for those with both parents having the history of stroke.</p>

Study on the baseline physical activity and the risk of ischemic cardiovascular diseases / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the associations between physical activity measures [metabolic equivalents of energy expenditure (MET) per hour per day] and ischemic cardiovascular diseases (ICVD) in Chinese population.</p><p><b>METHODS</b>A survey on cardiovascular risk factors was conducted in different areas of China in fall 1998. People aged 35 to 59 but without a history of coronary heart and stroke at baseline were prospectively followed and 11 849 subjects whose information were complete at the end of second follow-up were valid. Cox regression was used to estimate the hazard ratios (HRs) for incident ischemic cardiovascular diseases and the different measures of physical activity.</p><p><b>RESULTS</b>During a mean follow-up period of 5.9 years, 84 incident ischemic cardiovascular events were ascertained. We examined the HRs of ischemic cardiovascular events for a 1-unit change in METs value, which were included in the models as continuous variable. There were negative association of METs values found with ischemic cardiovascular events in total, urban, rural, male and female subjects, and statistical significance in the urban (HRs = 0.22, 95% CI: 0.05-0.95) but the association was weakened after adjustment for demographic factors. When further adjustment for other intermediate factors, the significance in the urban was again attenuated. When the urban males and females, rural males and females were divided into 3 groups according to their respective tertiles and the combination of different population groups, the factors of male/female and urban/ rural were equally distributed in different groups, and no more adjustment in the Cox model. The multivariate - adjusted (age and education attainment) HRs associated with the tertiles, from lowest to highest, were: 1, 1.03 and 0.65 (P(trend) = 0.170) for the total, 1, 0.72 and 0.64 for the urban, 1, 1.49 and 0.72 for the rural, 1, 1.05 and 0.59 for men, 1, 0.90 and 0.84 for women.</p><p><b>CONCLUSION</b>The totality of our findings pointed to METs per hour per day seemed to be weakly associated with a reduction in ischemic cardiovascular events incidence among urban middle-aged adults.</p>

Effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the effects of comprehensive interventions in community on smoking, chronic bronchitis, and asthma in rural areas of Beijing.</p><p><b>METHODS</b>Twenty-three villages in rural areas of Beijing were randomly divided into interventional (13 villages) and control villages (10 villages) in 1992. Comprehensive interventions including education of former-smokers and improvement of living environment were carried out in the interventional villages, and none was done in the control villages. In April 2000, surveys on smoking, chronic bronchitis, and asthma were carried out among 34,436 participants aged 15 or more in the interventional and control villages. During the same period, knowledge on prevention from chronic obstructive pulmonary diseases (COPD), living environments, and smoking were assessed among 1658 high-risk individuals of COPD at baseline and following-up period.</p><p><b>RESULTS</b>The scores of knowledge and improvement on living environments in the interventional villages were significantly higher than those in control villages (P < 0.001). The decrease rate of smoking and current smoking rate in the interventional villages were significantly higher than in the control villages (0.4% vs -0.8%, P < 0.001; 2.4% vs 1.3%, P < 0.001) in men, while not different in women (P > 0.05). Among never smokers at baseline, the accumulated incidence of smoking among people aged 15 to 24 from 1993 to 2000 was significantly lower in the interventional villages than in the control villages in men (18.9% vs 23.7%, P = 0.005) and in women (0% vs 0.7%, P = 0.005). Daily cigarettes smoked by smokers in the interventional villages were less than in control villages in both men (14.8 +/- 7.0 vs 17.2 +/- 8.2 cigs daily, P < 0.001) and women (12.8 +/- 6.9 vs 13.4 +/- 7.2 cigs daily, P = 0.088). The increase of prevalence of chronic bronchitis in the interventional villages was less than in the control villages (men: 0.9% vs 1.3%, P = 0.012; women: 0.1% vs 0.3%, P = 0.003). After the age factor is adjusted, odds ratio (OR) for accumulated incidence of chronic bronchitis from 1993 to 2000 in the interventional villages were 0.80 (95%CI: 0.60-1.07) for men, 0.76 (95%CI: 0.45-1.28) in women. The OR for asthma was not significant in both men and women.</p><p><b>CONCLUSIONS</b>Comprehensive interventions in community may improve knowledge of COPD prevention and living environments, decrease the smoking rate, cigarettes smoked per day, and incidence of chronic bronchitis, but have no significant effects on asthma.</p>

The current status on the prevalence, awareness, treatment and control of diabetes mellitus in several Chinese subpopulations / 中华流行病学杂志

<p><b>OBJECTIVE</b>To determine the prevalence of impaired fasting glucose (IFG), diabetes mellitus(DM), rates of awareness, treatment and control of DM in 14 Chinese subpopulations and the trends of development in recent years.</p><p><b>METHODS</b>We collected data on history regarding DM and fasting serum glucose in 14 Chinese subpopulations aged 35 to 59 in 1998, under cluster sampling. In 4 out of the 14 subpopulation samples, a similar survey using same methods in 1993 - 1994 was carried out. IFG and DM were diagnosed according to the WHO criteria.</p><p><b>RESULTS</b>The age-standardized prevalence rates of IFG and DM were from 0.5% to 15.6% (mean: 4.8%) and from 0.2% to 10.6% (mean: 4.3%) for the whole 14 subpopulations in 1998 which were not different between men and women, but higher in urban than in rural (P < 0.01), but increased with age (P < 0.01). The rates of awareness,treatment and control of DM were from 0% to 46.2% (mean: 33.3%), from 0% to 46.2% (mean: 27.2%), and from 0% to 15.4% (mean: 9.7%), which were significantly higher in women than in men (P < 0.01), higher in urban than in rural (P = 0.031), and higher in older participants (P < 0.05), but not much different in the levels of education. The rate of treatment in patients with awareness of DM and the rate of control in patients with treated DM were 81.6% and 35.6% respectively, which were not different between men and women, urban and rural or among different age groups. The mean prevalence of DM increased from 3.8% in 1993 - 1994 to 4.6% in 1998 (P = 0.037). The rates of awareness, treatment and control of DM had an increasing trends but with no significant differences between years 1993 - 1994 and 1998.</p><p><b>CONCLUSION</b>The prevalence of DM in 14 Chinese subpopulations exhibited no differences between men and women, but showing significant differences among areas and an increasing trend in the recent years. The rates of awareness, treatment, and control were still relatively low. To improve the efficacy of screening program and treatment seemed to be the two key issues in prevention and control of DM in China.</p>

The development and Assessment on the general quality of life intrument for Chinese people / 中华流行病学杂志

<p><b>OBJECTIVE</b>To develop a general quality of life (QOL) instrument for Chinese in accordance with the Chinese culture and to assess its reliability, validity and sensitivity.</p><p><b>METHODS</b>A 35-item QOL questionnaire(QOL-35) was developed with reference to the World Health Organization QOL questionnaire(WHO-100) and the 36-item medical outcomes study on short-form health status(SF-36). Thirty five items were divided into six domains (general, physical, independent, psychological, social, environment) and one item on QOL transition. The reliability of QOL-35 was assessed by a test-retest survey among 127 adults with an interval of 24-72 hours. The internal consistency and validity were evaluated by a survey on 135 adults from outpatients or general population, using QOL-35, WHO-100 and SF-36. The adaptability was assessed by application to 1356 community-based samples in Beijing.</p><p><b>RESULTS</b>(1)Test-retest reliability of QOL-35: weighted Kappa indexes for items were from 0.86 to 1.00. Intraclass correlation coefficients were from 0.68 to 0.94 for domains, and 0.94 for total score. (2) On internal consistency: Cronbach's Alphas were 0.93, 0.97 and 0.89 for QO1-35, WHO-100 and SF-36. (3)On construct validity. The accumulated proportions of variances of the preceding seven factors were 66.5%, 50.3% and 65.3% for QOL-35, WHO-100 and SF-36. (4) On criterion validity. Spearman correlation coefficients of total QOL score of QOL-35 with those of WHO-100 and SF-36 were 0.805 and 0.745. (5)The rates of chronic diseases were 53.1%, 33.1%, 26.4% and 25.1% from first to fourth quantile of the total QOL scores of QOL-35(P<0.05). (6)Cronbach's Alpha was from 0.68 to 0.93 in 135 subjects, and from 0.71 to 0.91 in 1356 individuals of natural population.</p><p><b>CONCLUSION</b>The QOL-35 instrument satisfied test-retest reliability and was highly correlated with WHO-100 and SF-36, having fewer items but better construction validity, better internal consistency, and better discrimination ability. We suggested that QOL-35 be used as a replicable tool to assess quality of life in the Chinese general population.</p>

Relationship between the severity, course, fatality of severe acute respiratory syndrome patients and the timing of hospitalization / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the relationship of timing of hospitalization and the severity, course, fatality of severe acute respiratory syndrome (SARS) patients.</p><p><b>METHOD</b>1291 hospital records of clinically diagnosed SARS patients with complete data gathered from "2003 Beijing SARS Clinical Database" were analyzed.</p><p><b>RESULTS</b>SARS cases were categorized into four groups, according to the time of hospitalization after onset of the disease: within 3 days, during day 4 to day 7, during day 8 to day 14 and after day 14. The numbers of cases for each group were 568, 496, 177 and 50 respectively. Data showed that from group 1 to 4, the prevalence rates of major symptoms on the first day of hospitalization were: (1) 9.7%, 16.5%, 23.1% and 24.0% for "feeling chest pain" (P < 0.001), (2) 7.4%, 13.7%, 19.2% and 22.0% for "suffering from breathing obstruction" (P < 0.001), (3) 32.8%, 44.8%, 59.9% and 48.0%, for "coughing" (P < 0.001) and (4) 14.1%, 22.4%, 27.1% and 18.0% for "coughing up phlegm" (P = 0.0002), respectively. The rates of high respiratory frequency (>or= 24 bits/min.) were 11.1%, 15.5%, 22.8% and 25.5% (P < 0.001). The rates of abnormal chest X-ray were 80.3%, 89.0%, 92.3% and 88.9%, respectively (P = 0.002). The average numbers of abnormal lung field (the lung were divided into 6 fields) were 1.7, 1.9, 2.5 and 2.6 (P < 0.001); The numbers of cases receiving continuous oxygen supply treatment were 33.6%, 50.0%, 53.7% and 74.0% (P < 0.001), and the numbers of cases receiving glucocorticosteroids treatment were 28.2%, 35.9%, 53.7% and 62.0% (P < 0.001), respectively. With cases having had chronic baseline diseases prior to SARS infection, the age-standardized fatality rates were 14.9%, 11.7%, 50.0% and 33.9% (P < 0.001), and the average courses of the disease were 30.3, 34.2, 42.9 and 47.5 days (P < 0.001), respectively. In cases without chronic baseline diseases, the age-standardized fatality rates were 5.3%, 9.8%, 9.2% and 8.3% (P = 0.101), and the average courses for each group were 32.4, 35.3, 40.9 and 47.6 days (P < 0.001), respectively.</p><p><b>CONCLUSION</b>Delayed hospitalization would cause the situation of SARS patient to deteriorate, losing the best chance for treatment and increase case fatality. In terms of control program on SARS, emphasize should be paid on decreasing the panic of patients to the disease so as to get early hospitalization.</p>