Prevalence of smoking in adults aged 40 years and above in China, 2019-2020 / 中华流行病学杂志

Objective: To understand the prevalence of smoking and its change in adults aged ≥40 years in China and provide evidence for the development of chronic obstructive pulmonary disease (COPD) prevention and control strategies. Methods: The data of this study were obtained from COPD surveillance in China during 2014-2015 and during 2019-2020. The surveillance covered 31 provinces (autonomous regions and municipalities). A multi-stage stratified cluster random sampling were used to select residents aged ≥40 years, and face-to-face interviews were conducted to collect the information about their tobacco use. After complex sampling weighting of the samples, the current smoking rate, average age to start smoking and average daily cigarette consumption of people with different characteristics during 2019-2020 were estimated, and the changes in the current smoking rate and average daily cigarette consumption were analyzed from 2014-2015 to 2019-2020. Results: During 2019-2020, the current smoking rate in adults aged ≥40 years was 27.2%, and the rate was much higher in men (52.1%) than in women (2.5%).The average age of the smokers to start smoking was 20.0 years old, and men usually started smoking at younger age (19.6 years) compared with women (27.9 years). The average daily cigarette consumption of daily smokers was 18.0 sticks, and the consumption of men (18.3 cigarettes) was higher than that of women (11.1 cigarettes). Compared with the surveillance results during 2014-2015, the current smoking rate had decreased by 2.8 percentage points in the general population, 4.1 percentage points in males, 1.6 percentage points in females, and the urban and rural areas fell by 3.1 percentage points and 2.5 percentage points, respectively. The average daily cigarette consumption decreased by 0.6 sticks. Conclusions: In recent years, the current smoking rate and average daily cigarette consumption in adults aged ≥40 years decreased in China, but smoking is still common in more than quarter of this population and more than half of men aged ≥40 years. It is necessary to take targeted tobacco control measures based on population and regional characteristics to further reduce the smoking level of the population.

Performance of pulmonary function test in people aged 40 years and above in China, 2019-2020 / 中华流行病学杂志

Objective: To understand the performance of pulmonary function tests in people aged ≥40 years and its changes in China, and provide evidence for the evaluation of the effect of chronic obstructive pulmonary disease (COPD) prevention and control in China. Methods: The subjects of the survey were from COPD surveillance during 2014-2015 and during 2019-2020, which covered 31 provinces (autonomous regions and municipalities) in China. The survey used multi-stage stratified cluster random sampling method, the trained investigators conducted face-to-face interview to know whether subjects had previous pulmonary function testing or not. Complex sampling weighting was used to estimate the rate of pulmonary function testing in people aged ≥40 years, and the pulmonary function testing rates of the two COPD surveillance periods were compared. Results: A total of 148 427 persons were included in the analysis, including 74 591 persons during 2014-2015 and 73 836 persons during 2019-2020. In 2019-2020, the pulmonary function testing rate in Chinese residents aged ≥40 years was 6.7% (95%CI: 5.2%-8.2%), the rate in men (8.1%, 95%CI: 6.7%-9.6%) was higher than that in women (5.4%, 95%CI: 3.7%- 7.0%), and the rate in urban residents (8.3%, 95%CI: 6.1%-10.5%) was higher than that in rural residents (4.4%, 95%CI: 3.8%-5.1%). The rate of pulmonary function testing increased with the increase of education level. During 2019-2020, the residents with history of chronic respiratory diseases had the highest rate of pulmonary function testing (21.2%, 95%CI: 16.8%-25.7%), followed by the residents with respiratory symptoms (15.1%, 95%CI: 11.8%-18.4%) , the pulmonary function testing rate in those who knew the name of chronic respiratory disease was higher than that in those who did not knew the name of respiratory disease, and the pulmonary function testing rate in former smokers was higher than that in current smokers and non-smokers. Those exposed to occupational dust and/or harmful gases had a higher rate of pulmonary function testing compared with those who were not exposed, and those who used polluted fuels indoors had a lower rate of pulmonary function testing than those who did not use polluted fuels indoors (all P<0.05). Compared with 2014-2015, the pulmonary function testing rate in residents aged ≥40 years in China increased by 1.9 percentage points during 2019-2020, and the rate of pulmonary function testing in groups with different characteristics all increased, and the rates of pulmonary function testing increased by 7.4 percentage points and 7.1 percentage points in residents with respiratory symptoms and in those with history of chronic respiratory diseases (all P<0.05). Conclusions: Compared with 2014-2015, the rate of pulmonary function testing increased in China during 2019-2020 and the increase in residents with history of chronic respiratory diseases and respiratory symptoms was relatively obvious, but the overall pulmonary function testing rate was still at a low level. Effective measures should be taken to further increase the rate of pulmonary function testing.

Prevalence of chronic respiratory symptoms and dyspnea and related factors in residents in China / 中华流行病学杂志

Objective: To understand the prevalence of chronic cough, chronic expectoration and dyspnea and related factors in residents aged ≥40 years in China, and provide basic data for the prevention and control of chronic respiratory diseases. Methods: Data were from 2014-2015 chronic obstructive pulmonary disease surveillance in China. The information about chronic respiratory symptoms were collected by face-to-face interview. The prevalence rates of chronic cough, chronic expectoration, dyspnea and chronic respiratory symptoms and their 95%CI were estimated with complex sampling weights. Results: A total of 75 082 subjects were included in the analysis. The prevalence rates of chronic cough, chronic expectoration, dyspnea and chronic respiratory symptoms in the Chinese aged ≥40 years were 3.75% (95%CI: 3.38%-4.11%), 5.83% (95%CI: 5.40%-6.26%), 2.45% (95%CI: 2.02%-2.87%) and 8.93% (95%CI: 8.25%-9.62%), respectively. The prevalence rates of chronic cough, chronic expectoration, dyspnea and chronic respiratory symptoms in patients with chronic respiratory diseases were relatively higher, which were 10.27%, 13.85%, 6.43%, 20.72% respectively. Multivariate logistic regression analysis showed that age, region, education level, occupation, BMI, family history of respiratory diseases, history of severe respiratory infections in childhood, exposure to dust or chemicals in workplace and smoking status affected the prevalence of chronic cough, chronic expectoration and dyspnea. The prevalence of the three types of chronic respiratory symptoms increased significantly with age, which were higher in western region, smokers and underweight/obese subjects. The three prevalence rates mentioned above were higher in those with a history of severe respiratory infection in childhood, those exposed to biomass fuel in household, and those exposed to dust or chemicals in workplace. Conclusions: The prevalence rate of chronic respiratory symptoms was high in residents aged ≥40 years in China. Many factors affected the prevalence of chronic respiratory symptoms. Comprehensive prevention and control measures targeting risk factors should be taken to reduce the burden of chronic respiratory diseases.

Analysis of partner attitude toward HIV infected pregnant women and its influencing factors in western China during 2005-2011 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze partner attitude change and influencing factors on HIV infected pregnant women HIV disclosure.</p><p><b>METHOD</b>A multi-stage cross sectional method was used to collect information by questionnaires on 1164 HIV infected pregnant women in 6 counties including Ruili and Longchuan in Yunnan, Hezhou, Lingshan and Pingxiang in Guangxi and Yining in Xinjiang. Information on demographic characteristics and sexual behavior of the subjects and partner attitude toward HIV infected pregnant women were obtained. The influencing factors of partner's discrimination against HIV infected pregnant women were analyzed.</p><p><b>RESULT</b>A total of 991(85.1%) HIV infected pregnant women have disclosed HIV status to partners among 1164 respondents and 39 (3.9%) reported they were discriminated against partners. Multivariate analysis showed that the 6.5% (15/231) of HIV infected pregnant women in urban had discrimination from their husbands while the ratio among rural pregnant women was lower(3.2% (24/760), OR = 0.40, 95%CI:0.12-0.77) . Compared with the ratio of discrimination among the women of first marriage(2.9%, 21/731), the discrimination ratio among women with remarriage and other status was higher (6.5% (15/232),OR = 2.45, 95%CI:1.61-5.25 and 10.7% (3/28),OR = 3.77, 95%CI:1.46-9.88) respectively. The discrimination ratio among pregnant women with multiple sexual partners was 5.9% (23/389), higher than women with single partner (2.6%, 15/580) (OR = 2.21, 95%CI:1.80-6.23).</p><p><b>CONCLUSION</b>The discrimination toward HIV infected pregnant women from husbands was related to demographic characteristics and sexual behaviors.</p>

Analysis on the intervention services status of prevention of mother to child transmission of HIV/AIDS in China / 中华预防医学杂志

<p><b>OBJECTIVE</b>The purpose of this study is to get to know the intervention services implementation status of prevention of mother to child transmission (PMTCT) of HIV/AIDS in China, and the trend of recent five years.</p><p><b>METHODS</b>We carried out relevant surveys and investigations among the areas where PMTCT work had been implemented during January 2005 to December 2009. Health providers in these fields provided routine maternal health care, HIV counseling and test for 10 360 655 pregnant women and comprehensive intervention measures to 10 123 HIV infected pregnant women which included antiretroviral (ARV) drugs usage, safety delivery, and exclusive breastfeeding, and collected relevant data and materials to analysis the ratio of main interventions and its change trend.</p><p><b>RESULTS</b>The HIV/AIDS counseling rate was increasing year by year (χ(2)(trend) = 3184.5, P < 0.001), during 2005 to 2009 the rate was 69.8% (406 151/581 975), 84.5% (1 346 745/1 594 579), 90.3% (1 582 757/1 753 191), 93.7% (1 926 224/2 055 232), 82.3% (3 599 228/4 375 678) respectively. HIV/AIDS test rate was increasing (χ(2)(trend) = 146 194.7, P < 0.001), the rate from 2005 to 2009 was 57.8% (336 459/581 975), 80.8% (1 287 812/1 594 579), 87.0% (1 524 595/1 753 191), 89.2% (1 833 246/2 055 232), 85.5% (3 741 337/4 375 678)respectively. The total number of HIV/AIDS infected maternities was 10 123 during 2005-2009, 6156 of them delivered, the general usage rate of ARVs was 71.0% (4373/6156), and increasing to 75.3% (1554/2065) by the end of 2009, the rates of 2005 to 2008 were 64.6% (362/560), 66.9% (623/931), 66.7% (857/1284), 74.2% (977/1316) respectively. The difference was significant (χ(2)(trend) = 47.6, P < 0.001). The proportion of using ARVs during pregnant period was 58.5% (2557/4373). The proportion of using ARVs among born infants of HIV infected maternities was 83.4% (4999/5994), and increasing yearly, 77.2% (409/530) of 2005, 80.1% (720/899) of 2006, 83.8% (1053/1257) of 2007, 89.4% (1116/1249) of 2008, 82.6% (1701/2059) of 2009, the difference was significant (χ(2)(trend) = 13.0, P < 0.001). The general rate of exclusive breastfeeding was 92.9% (5276/5681) and the rate of HIV test in 18 months was 74.6% (2482/3324).</p><p><b>CONCLUSION</b>The rate of HIV/AIDS counseling and test of general maternities is increasing and the proportion of mainly intervention measures have been increased year by year.</p>

Efficacy analysis of different antiretroviral drug regimens in mother to child HIV transmission prevention in some regions of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To determine the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention (PMTCT) in China.</p><p><b>METHODS</b>From January 1st 2006 to Dec 30th 2008, a total of 1072 pairs of HIV positive pregnant women and their babies who were HIV antibody positive and older than 18 months were recruited in this study. These women who had received maternal health care in health care institutions were from 23 provinces. Subjects were investigated by questionnaire, including social demographic data, usage of ARVs, safe delivery and artificial feeding, and other PMTCT related informations. The trend of different antiretroviral drug regiments in different period were analyzed by Cochran-Mantel-Haenszel (CMH) χ(2) test. By stratified analysis and Fisher exact χ(2) test, the efficacy of different antiretroviral drug regimens in mother to child HIV transmission prevention were studied. Antiretroviral drug regimens applications mainly included sd-NVP drug regimen, prophylaxis regimen and highly active anti-retroviral therapy (HAART).</p><p><b>RESULTS</b>Among 1072 pairs of HIV positive maternities and babies, 31 babies older than 18 months were HIV infected, MTCT rate was 2.9% (31/1072). (1) The proportion of using ARVs was increasing from 76.4% (306/395) in 2006 to 83.8% (372/444) in 2008, the difference was significant (CMH χ(2) = 6.4, P < 0.05). (2) The ratio that HIV infected maternities adopted ARVs rose from 3.4% (6/178) in 2006 to 26.3% (104/395) in 2008, the ratio increased year by year (CMH χ(2) = 53.1, P < 0.01). On the contrary, usage of sd-NVP declined from 88.8% (158/178) in 2006 to 70.9% (264/372) in 2008 (CMH χ(2) = 48.5, P < 0.01). (3) Among maternities adopted vaginal delivery and artificial feeding, the MTCT rate of ARVs combination group was 1.0% (1/104), while the MTCT rate of sd-NVP group was 5.9% (16/272) (Fisher χ(2) = 5.5, P < 0.05). (4) In the case of artificial feeding, the MTCT rate of prophylaxis regimens and HAART among maternities adopted vaginal delivery was 3.1% (1/32) and 0 respectively. Among maternities adopted cesarean delivery, MTCT rate of prophylaxis regimens and HAART was 3.2% (2/63) and 3.1%(1/32) respectively, both showed no significant difference (Fisher χ(2) = 1.4, P > 0.05; Fisher χ(2) = 0.0001, P > 0.05).</p><p><b>CONCLUSION</b>Effect of combination of antiretroviral drugs to PMTCT is obvious, the rate of mother to child HIV transmission of prophylaxis regimens and HAART has not shown significant difference.</p>

Impact of being informed of HIV sero-status on the utilization of mother-to-child HIV transmission prevention services before or after pregnancy / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the impact of being informed of HIV infection before or after pregnancy on the prevention of mother-to-child transmission (PMTCT) HIV interventions uptake.</p><p><b>METHODS</b>From 2005 to 2009, a tatal of 5552 HIV-infected pregnant women and their 5894 pregnancies in Henan, Guangxi, Yunnan and Xinjiang province were investigated using the method of a cohort study. The social-demographic characters (the objects were divided three age groups 15-, 25-, 35-49), the period identified to be HIV positive, the outcome of pregnancy and the PMTCT interventions including uptake of antiretroviral drugs (ARVs) were investigated. Through single-factor and non-conditional logistic regression model, the factors influencing the utilization of PMTCT services were analyzed.</p><p><b>RESULTS</b>Of HIV-infected pregnant women, 84.5% (4979/5894) were under 35 year-old, and 56.0% (3108/5552) of them were Han group and the percentage of peasant or unemployment was 85.1% (4727/5552). 86.8% (4815/5552) of these women had junior high school education or less, and the proportion of women knowing HIV infection before the pregnancy was 31.2% (1836/5894). Of HIV positive pregnant women, 31.7% (1869/5894) chose to terminate the pregnancy artificially, and the percentage was 43.8% (805/1836) among those knowing HIV infection before pregnancy. The proportion of the ARVs uptake among HIV positive maternities who delivered was 80.0% (3046/3808), while the percentage among those knowing HIV positive before pregnancy was 92.3% (883/957), which was much higher than it (75.9% (2163/2851)) among the pregnant women knowing HIV infection just during the pregnancy (χ(2) = 120.39, P < 0.05). The results of multivariate analysis showed that the proportion of ARVs' uptake was high among those HIV positive pregnant women knowing to be HIV-infected before pregnancy (versus knowing to be HIV-infected after the pregnancy, OR = 3.91 (95%CI: 3.03 - 5.05)) and age of 15 to 24 year-old (versus age of 35 - 49 year-old, OR = 0.75 (95%CI: 0.57 - 0.98)).</p><p><b>CONCLUSION</b>It will promote the HIV-infected pregnant women to receive the PMTCT intervention services if they know their HIV sero-status before pregnancy.</p>

The change trend of mother-to-child transmission rate of HIV-1 during 2005-2007 in some areas of China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the change trend of mother-to-child-transmission (MTCT) of HIV-1 in some areas in China.</p><p><b>METHODS</b>The investigation was conducted in 15 counties or districts of 4 provinces in China with relatively high HIV prevalence from January 2005 to June 2009. The data on the death and HIV-status of the babies born to HIV-positive mothers from January 2005-December 2007 in research sites were collected through 18-month following up after they were born.</p><p><b>RESULTS</b>During the time that the research was conducted, there were 644 babies born to HIV-positive mothers who were followed up for 18 months. At the end of 18 months, full data were collected from 550 babies, 44 babies were lost to follow-up and 50 babies died. Among 550 babies who were followed up for 18 months, 53 babies were confirmed as HIV positive. The rate of MTCT of HIV-1 was 13.19% (24/182), 8.90% (17/191) and 6.78% (12/177) in 2005, 2006, 2007 respectively, which showed a descending trend yearly (chi(2) = 4.23, P < 0.05). Adjusted by the death data of the HIV-exposed children, it was found that during 2005-2007 the rate of MTCT of HIV-1 was 16.74%, 12.98%, 9.52% respectively, which was also descending year by year (chi(2) = 4.69, P < 0.05).</p><p><b>CONCLUSION</b>Long-term, effective prevention of mother-to-child-transmission of HIV (PMTCT) could reduce the level of MTCT of HIV-1 year-by-year. In addition, using death data of HIV-exposed children to adjust the level of MTCT of HIV-1 is valuable to grade the effect of PMTCT.</p>

Influencing factors on the death of infants born to HIV infected mothers / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the influencing factors on the death of infants born to HIV infected mothers in areas with high prevalence of HIV/AIDS in China.</p><p><b>METHODS</b>Based on the follow-up cohort study targeting at HIV/AIDS infected pregnant women and their babies initiated in 2004, a survey on the death status and influencing factors on the infants born to HIV/AIDS infected mothers enrolled in this cohort from Jan.2004 to Nov.2007 was carried out during Aug.to Nov.2008 in seven counties of four provinces in China. A total of 498 pairs of HIV-infected mothers and their infants were enrolled and their related information was collected. Single factor and multiple factors Cox model methods were adopted for data analysis.</p><p><b>RESULTS</b>The total observed person-years of 498 infants was 406.22, among which, 45 infants died, and the mortality density was 110.78 per 1000 child-year. A single factor Cox model showed, the pregnancy in pre-period of HIV/AIDS and HIV/AIDS period (RR = 1.971, 95%CI: 1.143 - 3.396), living status of the pregnancy (RR = 3.062, 95%CI: 1.097 - 8.550), multipara women (RR = 0.517, 95%CI: 0.278 - 0.961), natural childbirth (RR = 0.561, 95%CI: 0.345 - 0.910), premature labor (RR = 5.302, 95%CI: 2.944 - 9.547), low birth weight (RR = 4.920, 95%CI: 2.691 - 8.994), mother-child pairs taking antiretroviral drugs (RR = 0.227, 95%CI: 0.121 - 0.428) and infants infected HIV (RR = 5.870, 95%CI: 3.232 - 10.660) could affect the infants death. The death of HIV-exposed infants was influenced by various factors. The death risk of infants born to HIV infected mothers who were in the danger of pre-period of HIV/AIDS and HIV/AIDS period was greater than the infants delivered by HIV infected mothers who were in preclinical period of HIV/AIDS (RR = 6.99, 95%CI: 1.92 - 25.64). The death risks were greater in the group that the women whose CD4(+)TLC count number lower than 200 cells/microl (RR = 2.05, 95%CI: 1.01 - 4.15). The infants whose mothers had no ARV treatment had higher possibility to die than the others (RR = 6.17, 95%CI: 1.62 - 23.26). The death risk of premature delivered infants was 2.87 times of mature delivered infants (95%CI: 1.12 - 7.35). The death risk of HIV/AIDS infected infants was 9.87 times of the HIV/AIDS uninfected infants (95%CI: 3.81 - 25.62).</p><p><b>CONCLUSION</b>Some measurements including improving HIV-infected pregnant women's immunity, reducing mother to child transmission of HIV and premature birth, low birth weight are beneficial to reducing infant mortality.</p>

Cost-effectiveness analysis for integrated prevention of mother-to-child transmission of HIV / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the cost-effectiveness and economic efficiency of integrated prevention of mother-to-child transmission (PMTCT) of HIV in four high-incidence counties.</p><p><b>METHODS</b>Data of local resource investment and total cost for PMTCT in 4 counties in China from 2003 to 2006 were collected. Cost analysis and cost-effectiveness analysis were conducted. Average costs of a confirmed HIV case, a prevented case and a disability-adjusted life-year (DALY) saving were calculated.</p><p><b>RESULTS</b>Average cost of identifying one HIV-infected mother was yen5512. Costs of a pediatric HIV case prevention and per DALY saving were yen46 747 and yen1870 ($231), respectively, based on the total cost perspective.</p><p><b>CONCLUSION</b>The cost of integrated prevention of mother-to-child transmission of HIV was low. The PMTCT program was economical efficiency.</p>