Analysis of the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019 / 中华劳动卫生职业病杂志

Objective: To analyze the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019, and to study the current burden of disease in relevant populations. Methods: In October 2021, based on data from the global burden of disease 2019 (GBD 2019) study, population attributable fraction (PAF), number of deaths, mortality, disability-adjusted life year (DALY) and DALY rate of Chinese and global populations with different ages and genders in 1990 and 2019 were extracted and analyzed. The rate of change was calculated, the mortality rate was normalized by the age structure of the world standard population, and the causes of disease burden caused by high temperature exposure of Chinese residents were analyzed. Results: In 2019, compared with 1990, the PAF of Chinese and global population decreased by 43.98% and 12.41% respectively, the number of deaths increased by 29.55% and 49.40% respectively, the crude mortality rate increased by 7.81% and 3.30% respectively, the DALY decreased by 48.12% and 14.41% respectively, and the DALY rate decreased by 56.82% and 40.82% respectively. The mortality rate of the ≥70 age group was higher than that of other groups. The disease burden indicators such as PAF, standardized mortality and DALY attributable to high temperature exposure in men were higher than those in women. In 2019, the main cause of DALY affected by high temperature exposure in Chinese population was ischemic heart disease (84400 person-years), and the main cause of death was ischemic heart disease (4900 cases). Conclusion: The burden of diseases attributable to high temperature exposure is still serious in China and the world at large. Targeted interventions should be formulated for men, the elderly and people with occupational exposure, and a sound surveillance system should be established to reduce the burden of diseases caused by high temperature exposure.

Estudio de Factibilidad para Evaluar la Proporción de Cáncer Atribuible a Factores de Riesgo Modificables en el Perú y Latinoamérica / Feasibility Study To Evaluate The Proportion Of Cancer Attributable To Modifiable Factors Of Risk In Peru And Latin America

Objetivo: Evaluar la factibilidad y validar de la propuesta metodológica para estimar la incidencia y mortalidad por cáncer atribuible a factores de riesgo modificables para el Perú y Latinoamérica. Métodos: Estudio piloto, ecológico a partir de fuentes secundarias. Se buscó y seleccionó los factores de riesgo modificables, prevalencia de exposicion, los riesgos relativos de dichos factores (RR) o una aproximación mediante la razón de posibilidades (OR). La información fue consignada en una ficha de recolección de datos la cual fue validada mediante juicio de expertos. Para el cálculo de la Fracción Atribuible Poblacional (FAP) se ensayó la fórmula planteada por Parkin y se desarrolló un modelo de simulación estadística con el software R. Studio V. 3.6.1. Resultados: En el Perú se cuenta con estudios de prevalencia para la mayoría de factores de riesgo modificables; asimismo, se dispone en Latinoamérica de estudios con estimaciones de OR para varios de los factores; sin embargo hubo que utilizar estudios de los Estados Unidos para los factores restantes. No hallamos estudios nacionales de radiaciones ionizantes ni ultravioleta. Se ensayó la sintaxis del modelo de simulación estadística la cual mostró ser válida y consistente con los resultados de estudios internacionales de FAP encontrándose dentro de los rangos de los estudios publicados. Conclusión: Es factible y viable realizar estudios de FAP de factores de riesgo modificables para cáncer en países de Latinoamérica, particularmente en el Perú, donde se cuenta con la información requerida para su estimación.

Objective: To evaluate the feasibility of the methodological proposal to estimate the incidence and mortality due to cancer attributable to modifiable risk factors for Peru and Latin America. Methods: Pilot study, ecological from secondary sources. Modifiable risk factors, exposure prevalence, relative risks of these factors (RR) or an approximation by means of possibilities ratio (OR) were searched and selected. The information was recorded in a data collection form which was validated by expert judgment. For the calculation of the Population Attributable Fraction (FAP), the formula proposed by Parkin was tested and a statistical simulation model was developed with R. Studio V. 3.6.1 software. Results: In Peru there are prevalence studies for the majority of modifiable risk factors; Likewise, studies with OR estimates for several of the factors are available in Latin America; however, studies from the United States had to be used for the remaining factors. No national studies of ionizing or ultraviolet radiation were found. The syntax of the statistical simulation model was tested, which proved to be valid and consistent with the results of international FAP studies within the ranges of published studies. Conclusion: It is feasible and viable to carry out PAF studies of modifiable risk factors for cancer in Latin American countries, particularly in Peru, where the information required for its estimation is available.

Burden of Disease Due to Secondhand Smoke among Korean Adults at Sub-National Level

BACKGROUND: Exposure to secondhand smoke (SHS) is one of the biggest health hazards. Quantifying the related burden of disease (BOD) is a powerful tool for making evidence-based policies. This study calculated the BOD due to SHS at sub-national level using the most recent statistics of Korea. METHODS: SHS related diseases were selected by the systematic review of previous studies. Population attributable fraction (PAF) was calculated by using the standard formula using prevalence of exposure derived from Community Health Survey (CHS) 2013. SHS burden was calculated by multiplying nonsmoker's disability adjusted life years (DALYs) with PAF of SHS. RESULTS: SHS burden at sub-national level ranged between 460 DALYs in Cheonan to 5 DALYs in Pyeongtaek, Songtan region. Median of DALY was highest in districts of metropolitan cities and lowest in small towns and rural areas. Twelve out of fifteen regions with highest DALY per 1,000 were small towns and rural areas. Gender and age standardized DALY was highest in Seogwipo (west) in Jeju-do (1.66/1,000) and lowest in Dong-gu, Ulsan (0.17/1,000). CONCLUSION: There were substantial variations between regions according to BOD. Regional governments should implement policies according to specific situation in each region and regular monitoring should be done by calculating BOD. Big cities need to focus more on control of active and SHS prevalence. Resources in small towns and rural areas need to be allocated more towards implementation of screening programs, early diagnosis and treatment of diseases especially in the elderly population.

Environmental Tobacco Smoke Exposure at Home and Attributable Problem Behaviors in Korean Children and Adolescents for 2012–2014 in a Nationally Representative Survey

BACKGROUND: This study aimed to examine the environmental tobacco smoke (ETS) exposure at home and associated problem behaviors in Korean children and adolescents. METHODS: Approximately 2,167 children aged 3–18 years were included in the study after excluding 163 active smokers from the Korean Environmental Health Survey in Children and Adolescents (2012–2014). ETS data were obtained using a questionnaire; problem behaviors were measured using the Child Behavior Checklist administered to parents. The relationship between ETS exposure and problem behavior was evaluated using a survey regression model adjusted for region, age, sex, income, and father's education. The population-attributable fraction (PAF%) was calculated based on problem behaviors related to ETS exposure at home. RESULTS: The rates of ETS exposure at home were 20%, 28%, and 39% in children aged 3–5, 6–11, and 12–18 years, respectively; ETS exposure at home was associated with behavioral problems: the exposed group having higher total behavioral problem score (95% confidence interval [CI]) than the non-exposed by 2.46 (0.60–4.32) and 2.74 (0.74–4.74) in children aged 6–11 and 12–18 years, respectively, with no significant association in those aged 3–5 years. The PAF% (95% CI) of total problem behaviors for ETS exposure at home were 2.68 (−10.11–17.78), 10.66 (3.25–17.55), and 11.62 (3.03–18.96) in children aged 3–5, 6–11, and 12–18 years, respectively. Children with externalizing problems had higher PAF% than those with internalizing problems. CONCLUSION: In Korea, ETS exposure at home is associated with problem behaviors in children and adolescents with about more than 10% population attributable fraction.

The Disease Burden of Lung Cancer Attributable to Residential Radon Exposure in Korean Homes

BACKGROUND: Residential radon exposure is known to be an important risk factor for the development of lung cancer. The objective of this study was to calculate the disease burden of lung cancer attributable to residential radon exposure in Korea. METHODS: We calculated the national exposure level using Korean national radon survey data from 2011 to 2014, and house structure distribution data from each administrative region. Using the exposure-risk function, the population attributable fraction (PAF) was calculated and applied to calculate the disease burden for lung cancer attributable to residential radon exposure. RESULTS: Residential radon exposure levels were the highest, at 116.4 ± 50.4 Bq/m3 (annual mean radon concentration ± standard deviation) in detached houses, followed by 74.1 ± 30.0 Bq/m3 in the multi-family dwellings, and 55.9 ± 21.1 Bq/m3 in apartments. The PAF for lung cancer, due to long-term radon exposure in Korean homes, was 6.6% and 4.7% in men and women, respectively. The total disease burden of lung cancer attributable to residential radon exposure was 14,866 years of life lost (YLL) and 1,586 years lost due to disability (YLD) in 2013. Overall, 1,039 deaths occurred due to residential radon exposure, of which 828 were in men and 211 in women. CONCLUSION: The smoking rate of men in Korea exceeded 70% in the 1990s, and is still near 40%. Although the size of the effect varies depending on the estimation method, it is a critical aspect as a risk factor of lung cancer because of the synergistic relationship between smoking and radon exposure. Because the Korean society is rapidly aging, population who were formerly heavy-smokers are entering a high-risk age of lung cancer. Therefore, it is necessary to inform the public about the health benefits of reduced radon exposure and to strengthen the risk communication.

Burden Of Disease Attributable To Overweight And Obesity In Malaysia

@#The overweight and obese population may affect the population health which can lead to economic stability and development of the countries to be compromised. Thus, this study estimates the burden of disease attributable to overweight and obesity in Malaysia for adults aged 20-59 years old. Population attribution fraction (PAF) and disability-adjusted life year (DALY) have been used to quantify years of life lost from premature death and number of years lost due to disability resulting from obesity and overweight. The burden of disease attributable to overweight was 1582 and 1146 PYs per 1000 persons for male and female, respectively. Meanwhile, the burden of disease attributable to obesity was 2951 PYs per 1000 persons with women in the lead at 1657 PYs per 1000 persons. The burden of overweight and obesity among Malaysian adults is substantial. The outcome of this study is crucial as it gives a comprehensive information on the burden of overweight and obesity in Malaysia. The information from this study also enables the authorities to develop activities and programs to combat obesity and tomaintain healthy lifestyle among Malaysian.

Burden of cardiovascular diseases attributable to metabolism disorders, in Jiangsu province / 中华流行病学杂志

Objective To quantify the burden of cardiovascular disease (CVD) deaths that attributed to metabolic disorders in population aged ≥25 years in Jiangsu province.Methods The data we used were from the following three sources:1) 2015 Jiangsu Chronic Disease Risk Factor and Nutrition Survey,2) death surveillance,3) results of the 2016 Global Burden of Disease Study,based on population attributable fractions (PAF),to analyze related parameters as mortality,years of life lost (YLL),life expectancy (LE) and premature mortality.Results Most people died from ischemic stroke (IS) showed the standard mortality as 87.48/100 000.High SBP appeared as the major cause on CVD deaths.PAF with high cholesterol and high BMI decreased along with the increase of age while high fasting plasma glucose increased.Deaths due to ischemic heart diseases,IS or hemorrhagic stroke that attributed to metabolism disorders would reduce the LE by 1.08,1.07 or 0.55 years,respectively.Males appeared to have higher YLL than females and were more likely to die from premature CVD,as the consequence of having metabolism disorders.Conclusions Blood pressure control should be considered an important approach to reduce the burden of CVD.According to the characteristics of gender-related risks and the distinct impact of age-related metabolism disorders on different CVD diseases,stratified strategies should be strengthened for comprehensive prevention and control of CVD,in Jiangsu province.

Burden of cardiovascular diseases attributable to metabolism disorders, in Jiangsu province / 中华流行病学杂志

Objective To quantify the burden of cardiovascular disease (CVD) deaths that attributed to metabolic disorders in population aged ≥25 years in Jiangsu province.Methods The data we used were from the following three sources:1) 2015 Jiangsu Chronic Disease Risk Factor and Nutrition Survey,2) death surveillance,3) results of the 2016 Global Burden of Disease Study,based on population attributable fractions (PAF),to analyze related parameters as mortality,years of life lost (YLL),life expectancy (LE) and premature mortality.Results Most people died from ischemic stroke (IS) showed the standard mortality as 87.48/100 000.High SBP appeared as the major cause on CVD deaths.PAF with high cholesterol and high BMI decreased along with the increase of age while high fasting plasma glucose increased.Deaths due to ischemic heart diseases,IS or hemorrhagic stroke that attributed to metabolism disorders would reduce the LE by 1.08,1.07 or 0.55 years,respectively.Males appeared to have higher YLL than females and were more likely to die from premature CVD,as the consequence of having metabolism disorders.Conclusions Blood pressure control should be considered an important approach to reduce the burden of CVD.According to the characteristics of gender-related risks and the distinct impact of age-related metabolism disorders on different CVD diseases,stratified strategies should be strengthened for comprehensive prevention and control of CVD,in Jiangsu province.

Survey on burden of disease attributable to low fruit intake among Chinese people aged 15 years old and above between 1990 and 2013 / 中华预防医学杂志

Objective@#To analyze the burden of disease attributable to low fruit intake among Chinese population aged ≥15 years old between 1990 and 2013.@*Methods@#We used data from the 2013 Global Burden of Disease Burden of Disease Study to study the situation in China. The population attributable fraction was calculated to estimate and compare the death and disability-adjusted life years (DALY) attributed to low fruit intake between 1990 and 2013 in China (excluded Taiwan, China). An average world population age structure of the period 2000-2025 was adopted to calculate age-standardized rates.@*Results@#Deaths attributable to low fruit intake accounted for 11.02% of all death in 2013, which were higher than it in 1990 (10.38%). In 2013, the number of deaths attributed to low fruit intake in China increased to 1 046 500 from 793 800 in 1990. From 1990-2013, the age-standardized death rate attributable to low fruit intake decreased from 113.04/100 000 to 79.80/100 000. DALYs caused by low fruit intake increased from 18.346 5 million in 1990 to 21.296 7 million in 2013. Compared with 1990, the age-standardized DALY rate attributed to low fruit intake decreased by 34.67%. In 2013, the top three provinces with the highest burden of disease attributed to low fruits intake were Tibet, Guizhou and Xinjiang provinces, with standardized DALY rate at 2 612.53/100 000, 2 281.85/100 000 and 2 198.22/100 000, respectively. Compared with the results in 1990, the standardized DALY attributed to low fruits intake decreased, especially in Tianjin, where decreased by 63.61%; followed by Aomen, Zhejiang, Shanghai and Beijing, where decreased by 59.74%, 59.53%, 56.64% and 53.88%, respectively.@*Conclusion@#Compared with the situation in 1990, the burden of disease attributable to low fruit intake decreased in 2013, but the situation is still serious, especially in Tibet, Guizhou and Xinjiang provinces, where the burden decreased comparatively slowly.

Deaths and life expectancy losses attributable to diet high in sodium in China / 中华流行病学杂志

Objective To quantitatively estimate the deaths and life expectancy losses attributable to diet high in sodium in China,and examine the gains and shifts under different control scenarios of sodium consumption.Methods Based on data from the cause-of-death through the National Mortality Surveillance System,and 24 hours urinary sodium values from Global Burden of Disease study on Chinese's estimates,population attributable fractions with the framework of comparative risk assessment were used to analyze the deaths and life expectancy losses due to diet high in sodium.The same methods were followed to examine the gains and shifts under different control scenarios of sodium consumption.Results In 2013,1 430 (940 for men and 490 for women)thousand deaths were attributable to diet high in sodium,accounting for 15.6％ (17.4％ for men and 13.0％ for women) of all-cause deaths in China,which causing 2.17 (2.49 for men and 1.71 for women) years of life expectancy loss.Diet with high sodium in 2013 caused 1 200,50 and 180 thousand deaths from cardiovascular disease,chronic kidney disease and stomach cancer respectively,accounting for 31.5％,30.8％ and 64.8％ of those specific causes.Comparing to the baseline in 2013,if the targets of 10％ decrease of sodium consumption by 2020 and 15％ by 2030 for Chinese chronic disease prevention and treatment planning,and 30％ decrease by 2030 for WHO non-communicable disease monitoring framework are achieved,220,340 and 730 thousand deaths will be averted,which may gain 0.30,0.45 and 0.95 years of life expectancy,respectively.Conclusions As one of the leading risk factors,diet high in sodium had caused heavy burden of disease from cardiovascular disease,chronic kidney disease and stomach cancer on Chinese residents.Intervention programs on sodium-reductionare urgently needed in China and related cost-effectiveness is highly expected.

The effect of high total cholesterol on life expectancy in 2013 in China / 中华流行病学杂志

Objective To estimate the effect of high total cholesterol (TC) on life expectancy in China.Methods Population attributable fractions (PAF) of high TC were calculated in both urban,rural areas and regions,using data related to TC levels from the chronic disease risk factor surveillance in China,2013.Together with PAFs,data related to death registry,demographics,attributable deaths from high TC and its effect on life expectancy,were estimated.Results In 2013,the TC level in Chinese population aged 25 and above appeared as (4.8± 1.0) mmol/L,higher in urban areas [(4.8±1.0) mmol/L] than that in rural areas [(4.7± 1.0) mmol/L)],with the highest in eastern regions [(4.9 ±1.0) mmol/L] and lowest in the central regions [(4.6 ± 1.0) mmol/L].TC level appeared as (4.8 ± 1.0)mmol/L in both sexes.A total of 2.9％ of all the deaths were attributed to high TC (264 998 deaths),among which 89.3％ were caused by ischemic heart disease (236 540 deaths).PAF was seen higher in females (3.7％) than that in males (2.3％),higher in urban (3.4％) than that in rural areas (2.4％),with the highest in eastern (3.7％) and lowest in western regions (2.1％).Mortality that attributed to high TC was 19.6/100 000,higher in females (21.2/100 000) than that in males (18.0/100 000),higher in urban (20.8/100 000) than that in rural areas (18.2/100 000),with the highest in eastern (23.2/100 000) and lowest in western regions (15.6/100 000).In 2013,the loss of life expectancy that caused by high TC was 0.30 year,higher in females (0.35 year) than in males (0.26 year),higher in urban (0.34 year) than that in rural areas (0.28 year),with the highest seen in the eastern (0.36 year) and lowest (0.23 year) in the western regions.Conclusion In 2013,the effect of high TC on life expectancy appeared different between genders,urban and rural areas or regions,with greater impact on females,urban and eastern areas of the country.

Mortality and life expectancy that attributable to high blood pressure in Chinese people in 2013 / 中华流行病学杂志

Objective To estimate the deaths (mortality) and life expectancy that attributable to high blood pressure in people from different regions and gender,in China in 2013.Methods Data was from the ‘China Chronic Disease Risk Factor Surveillance 2013'and the ‘China National Mortality Surveillance 2013'.According to the comparative risk assessment theory,population attributable fraction (PAF) of high blood pressure by gender,urban-rural,east-central-west regions was calculated before the estimations on deaths (mortality) and life expectancy attributable to high blood pressure was made.Results In 2013,among the Chinese people aged 25 years old and above,the mean SBP was (129.48 ± 20.27) mmHg.High blood pressure [SBP＞(115 ± 6) mmHg] caused 20.879 million deaths and accounted for 22.78％ of the total deaths.SBP,deaths,mortality rate and standardized mortality rate that attributable to high blood pressure all appeared higher in men [(131.15 ± 18.73) mmHg,11.517 million,165.56/100 000 and 106.97/100 000,respectively] than in women [(127.79 ± 21.60) mmHg,9.362 million,141.99/100 000 and 68.93/100 000,respectively].SBP,deaths,mortality rate and PAF were all seen higher in rural [(130.25±20.66) mmHg,11.234 million,178.58/100 000 and 23.59％,respectively] than in urban [(128.58± 19.77) mmHg,9.645 million,132.87/100 000 and 21.54％,respectively] areas.However,levels of SBP were similar in the east,central or west regions,with attributable deaths,attributable mortality rate and PAF the highest as 7.658 million 179.93/100 000,and 26.72％ respectively.In 2013,among the Chinese people aged 25 years old and above,deaths caused by cardiovascular disease and chronic kidney disease attributable to high blood pressure were 19.912 million and 0.966 million,accounting for 52.31％ of the total deaths due to cardiovascular diseases and 62.11％ to the total chronic kidney diseases.The top three deaths attributable to high blood pressure were ischemic heart disease (6.656 million),hemorrhagic stroke (5.331 million) and ischemic stroke (3.593 million).When the effect of high blood pressure had been eliminated,the life expectancy per capita would have increased by 2.86 years old,with higher in women than in men (3.07 and 2.64 years old,respectively),higher in central than in east and west (3.48,2.56 and 2.58 years,respectively) areas,in rural than in urban (2.97 and 2.59 years,respectively) areas.Conclusions In 2013,the number of deaths attributable to high blood pressure was around 20.9 million,accounting for 22.78％ of the total deaths,and appeared higher in men than in women,in rural than in urban,in central than in east and west areas.The mortality burden induced by ischemic heart disease,hemorrhagic stroke and ischemic stroke was most serious since the high blood pressure brought about 2.86 years of lost in life expectancy.

Death and impact of life expectancy attributable to smoking in China, 2013 / 中华流行病学杂志

Objective To analyze the death attributable to smoking and impact of life expectancy in China in 2013.Methods According to the characteristics of different diseases,we calculated the population attributable fractions of different diseases,death and impact of life expectancy which caused by smoking,using direct method (current smoking rate as exposure levels)and indirect method (smoking impact ratio as exposure levels),based on data from both programs of death surveillance and Chinese chronic disease risk factor surveillance of 2013.Results In 2013,smoking caused around 1.59 million deaths which accounted for 17.38％ of all deaths in China.Constituent ratio of death caused by smoking in males (23.66％) was much higher than that in females (8.30％).However,in urban areas (17.24％),it was slightly lower than that in rural areas (17.51％).Constituent ratio of death caused by smoking in the eastern regions appeared the lowest (16.81％),with western regions the highest (17.91％).In 2013,lung cancer,COPD and ischemia heart disease were the top three diseases causing deaths that related to smoking,but the top three population attributable fractions were lung cancer,COPD and nasopharyngeal carcinoma in China.In 2013,smoking caused a reduction of 2.04 years of life expectancy loss in China,with males in the western regions the highest (3.05 years).Conclusion Smoking is still an important public health problem in China.Tobacco-control-targeted programs in the heavily involved areas could reduce the number of deaths from related diseases that caused by smoking.

Deaths and life expectancy losses attributable to diet high in sodium in China / 中华流行病学杂志

Objective To quantitatively estimate the deaths and life expectancy losses attributable to diet high in sodium in China,and examine the gains and shifts under different control scenarios of sodium consumption.Methods Based on data from the cause-of-death through the National Mortality Surveillance System,and 24 hours urinary sodium values from Global Burden of Disease study on Chinese's estimates,population attributable fractions with the framework of comparative risk assessment were used to analyze the deaths and life expectancy losses due to diet high in sodium.The same methods were followed to examine the gains and shifts under different control scenarios of sodium consumption.Results In 2013,1 430 (940 for men and 490 for women)thousand deaths were attributable to diet high in sodium,accounting for 15.6％ (17.4％ for men and 13.0％ for women) of all-cause deaths in China,which causing 2.17 (2.49 for men and 1.71 for women) years of life expectancy loss.Diet with high sodium in 2013 caused 1 200,50 and 180 thousand deaths from cardiovascular disease,chronic kidney disease and stomach cancer respectively,accounting for 31.5％,30.8％ and 64.8％ of those specific causes.Comparing to the baseline in 2013,if the targets of 10％ decrease of sodium consumption by 2020 and 15％ by 2030 for Chinese chronic disease prevention and treatment planning,and 30％ decrease by 2030 for WHO non-communicable disease monitoring framework are achieved,220,340 and 730 thousand deaths will be averted,which may gain 0.30,0.45 and 0.95 years of life expectancy,respectively.Conclusions As one of the leading risk factors,diet high in sodium had caused heavy burden of disease from cardiovascular disease,chronic kidney disease and stomach cancer on Chinese residents.Intervention programs on sodium-reductionare urgently needed in China and related cost-effectiveness is highly expected.

The effect of high total cholesterol on life expectancy in 2013 in China / 中华流行病学杂志

Objective To estimate the effect of high total cholesterol (TC) on life expectancy in China.Methods Population attributable fractions (PAF) of high TC were calculated in both urban,rural areas and regions,using data related to TC levels from the chronic disease risk factor surveillance in China,2013.Together with PAFs,data related to death registry,demographics,attributable deaths from high TC and its effect on life expectancy,were estimated.Results In 2013,the TC level in Chinese population aged 25 and above appeared as (4.8± 1.0) mmol/L,higher in urban areas [(4.8±1.0) mmol/L] than that in rural areas [(4.7± 1.0) mmol/L)],with the highest in eastern regions [(4.9 ±1.0) mmol/L] and lowest in the central regions [(4.6 ± 1.0) mmol/L].TC level appeared as (4.8 ± 1.0)mmol/L in both sexes.A total of 2.9％ of all the deaths were attributed to high TC (264 998 deaths),among which 89.3％ were caused by ischemic heart disease (236 540 deaths).PAF was seen higher in females (3.7％) than that in males (2.3％),higher in urban (3.4％) than that in rural areas (2.4％),with the highest in eastern (3.7％) and lowest in western regions (2.1％).Mortality that attributed to high TC was 19.6/100 000,higher in females (21.2/100 000) than that in males (18.0/100 000),higher in urban (20.8/100 000) than that in rural areas (18.2/100 000),with the highest in eastern (23.2/100 000) and lowest in western regions (15.6/100 000).In 2013,the loss of life expectancy that caused by high TC was 0.30 year,higher in females (0.35 year) than in males (0.26 year),higher in urban (0.34 year) than that in rural areas (0.28 year),with the highest seen in the eastern (0.36 year) and lowest (0.23 year) in the western regions.Conclusion In 2013,the effect of high TC on life expectancy appeared different between genders,urban and rural areas or regions,with greater impact on females,urban and eastern areas of the country.

Mortality and life expectancy that attributable to high blood pressure in Chinese people in 2013 / 中华流行病学杂志

Objective To estimate the deaths (mortality) and life expectancy that attributable to high blood pressure in people from different regions and gender,in China in 2013.Methods Data was from the ‘China Chronic Disease Risk Factor Surveillance 2013'and the ‘China National Mortality Surveillance 2013'.According to the comparative risk assessment theory,population attributable fraction (PAF) of high blood pressure by gender,urban-rural,east-central-west regions was calculated before the estimations on deaths (mortality) and life expectancy attributable to high blood pressure was made.Results In 2013,among the Chinese people aged 25 years old and above,the mean SBP was (129.48 ± 20.27) mmHg.High blood pressure [SBP＞(115 ± 6) mmHg] caused 20.879 million deaths and accounted for 22.78％ of the total deaths.SBP,deaths,mortality rate and standardized mortality rate that attributable to high blood pressure all appeared higher in men [(131.15 ± 18.73) mmHg,11.517 million,165.56/100 000 and 106.97/100 000,respectively] than in women [(127.79 ± 21.60) mmHg,9.362 million,141.99/100 000 and 68.93/100 000,respectively].SBP,deaths,mortality rate and PAF were all seen higher in rural [(130.25±20.66) mmHg,11.234 million,178.58/100 000 and 23.59％,respectively] than in urban [(128.58± 19.77) mmHg,9.645 million,132.87/100 000 and 21.54％,respectively] areas.However,levels of SBP were similar in the east,central or west regions,with attributable deaths,attributable mortality rate and PAF the highest as 7.658 million 179.93/100 000,and 26.72％ respectively.In 2013,among the Chinese people aged 25 years old and above,deaths caused by cardiovascular disease and chronic kidney disease attributable to high blood pressure were 19.912 million and 0.966 million,accounting for 52.31％ of the total deaths due to cardiovascular diseases and 62.11％ to the total chronic kidney diseases.The top three deaths attributable to high blood pressure were ischemic heart disease (6.656 million),hemorrhagic stroke (5.331 million) and ischemic stroke (3.593 million).When the effect of high blood pressure had been eliminated,the life expectancy per capita would have increased by 2.86 years old,with higher in women than in men (3.07 and 2.64 years old,respectively),higher in central than in east and west (3.48,2.56 and 2.58 years,respectively) areas,in rural than in urban (2.97 and 2.59 years,respectively) areas.Conclusions In 2013,the number of deaths attributable to high blood pressure was around 20.9 million,accounting for 22.78％ of the total deaths,and appeared higher in men than in women,in rural than in urban,in central than in east and west areas.The mortality burden induced by ischemic heart disease,hemorrhagic stroke and ischemic stroke was most serious since the high blood pressure brought about 2.86 years of lost in life expectancy.

Death and impact of life expectancy attributable to smoking in China, 2013 / 中华流行病学杂志

Objective To analyze the death attributable to smoking and impact of life expectancy in China in 2013.Methods According to the characteristics of different diseases,we calculated the population attributable fractions of different diseases,death and impact of life expectancy which caused by smoking,using direct method (current smoking rate as exposure levels)and indirect method (smoking impact ratio as exposure levels),based on data from both programs of death surveillance and Chinese chronic disease risk factor surveillance of 2013.Results In 2013,smoking caused around 1.59 million deaths which accounted for 17.38％ of all deaths in China.Constituent ratio of death caused by smoking in males (23.66％) was much higher than that in females (8.30％).However,in urban areas (17.24％),it was slightly lower than that in rural areas (17.51％).Constituent ratio of death caused by smoking in the eastern regions appeared the lowest (16.81％),with western regions the highest (17.91％).In 2013,lung cancer,COPD and ischemia heart disease were the top three diseases causing deaths that related to smoking,but the top three population attributable fractions were lung cancer,COPD and nasopharyngeal carcinoma in China.In 2013,smoking caused a reduction of 2.04 years of life expectancy loss in China,with males in the western regions the highest (3.05 years).Conclusion Smoking is still an important public health problem in China.Tobacco-control-targeted programs in the heavily involved areas could reduce the number of deaths from related diseases that caused by smoking.

Estimation of the population attributable fraction of road-related injuries due to speeding and passing in Iran / 한국역학회지

OBJECTIVES: Speeding and passing are considered to be the main human factors resulting in road traffic injuries (RTIs). This study aimed to estimate the population attributeable fraction (PAF) of speeding and passing in RTIs in rural Iran during 2012. METHODS: The contribution of speeding and passing to RTI-related morbidity and mortality was estimated using the PAF method. The prevalence of speeding and passing was obtained from the national traffic police data registry. A logistic regression model was used to measure the association between the above risk factors and RTIs. RESULTS: Speeding accounted for 20.96% and 16.61% of rural road-related deaths and injuries, respectively. The corresponding values for passing were 13.50% and 13.44%, respectively. Jointly, the PAF of these factors was 31.63% for road-related deaths and 27.81% for injuries. CONCLUSIONS: This study illustrates the importance of controlling speeding and passing as a high-priority aspect of public-health approaches to RTIs in Iran. It is recommended that laws restricting speeding and passing be enforced more strictly.

Alcohol as a Risk Factor for Cancer: Existing Evidence in a Global Perspective / 예방의학회지

The purpose of the present review is to give an overview of the association between alcohol intake and the risk of developing cancer. Two large-scale expert reports; the World Cancer Research Fund (WCRF)/American Institute of Cancer Research (AICR) report from 2007, including its continuous update project, and the International Agency for Research of Cancer (IARC) monograph from 2012 have extensively reviewed this association in the last decade. We summarize and compare their findings, as well as relate these to the public health impact, with a particular focus on region-specific drinking patterns and disease tendencies. Our findings show that alcohol intake is strongly linked to the risk of developing cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum (in men), and female breast. The two expert reports diverge on the evidence for an association with liver cancer and colorectal cancer in women, which the IARC grades as convincing, but the WCRF/AICR as probable. Despite these discrepancies, there does, however, not seem to be any doubt, that the Population Attributable Fraction of alcohol in relation to cancer is large. As alcohol intake varies largely worldwide, so does, however, also the Population Attributable Fractions, ranging from 10% in Europe to almost 0% in countries where alcohol use is banned. Given the World Health Organization's prediction, that alcohol intake is increasing, especially in low- and middle-income countries, and steadily high in high-income countries, the need for preventive efforts to curb the number of alcohol-related cancers seems growing, as well as the need for taking a region- and gender-specific approach in both future campaigns as well as future research. The review acknowledges the potential beneficial effects of small doses of alcohol in relation to ischaemic heart disease, but a discussion of this lies without the scope of the present study.

Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India.

BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case–control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use‑attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age‑sex groups were obtained from UN estimates (2010 revision) for 2008. A meta‑relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta‑analysis on all‑cause mortality from SLT use in India including four cohort and one case–control study. The studies included in the meta‑analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27–1.42) and 1.17 (1.05–1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three‑fifth (60%) of these deaths occurring among women. CON CLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three‑fifth of SLT use‑attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.