Burden of epilepsy in China and its provinces, 1990 to 2019: findings from the Global Burden of Disease Study 2019 / 中华医学杂志(英文版)

BACKGROUND@#Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces.@*METHODS@#We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019.@*RESULTS@#In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92-1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95% UI: 71.33-133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95% UI: 8.03-98.74%) and 35.72% (95% UI: 0.47-86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95% UI: 1.43-5.66]/100,000), Qinghai (1.80 [95% UI: 1.15-2.36]/100,000), and Yunnan (1.30 [95% UI: 0.88-1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95% UI: 0.39-0.64]/100,000), Zhejiang (0.56 [95% UI: 0.44-0.70]/100,000), and Shanghai (0.57 [95% UI: 0.41-0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased.@*CONCLUSIONS@#The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.

Construction of AQHI based on joint effects of multi-pollutants in 5 provinces of China / 环境与职业医学

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO2, NO2, CO, PM2.5, PM10, and maximum 8 h O3 concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM2.5, NO2, SO2, and O3 were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM2.5, NO2, SO2 and O3 were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Analysis of death status and change trend of asthma among Chinese people aged 0-19 years from 2008 to 2018 / 中华实用儿科临床杂志

Objective:To analyze the death rate of asthma among Chinese people aged 0-19 years in 2018 and the trend of asthma mortality between 2008 and 2018, in order to guide the research of asthma control management and prevention strategy, and reduce the mortality of childhood asthma in China.Methods:Data from the national disease surveillance points system (DSPs) was adopted.The mortality rates of 0-19-year-old people in different age groups, genders, places of residence and geographical regions from 2008 to 2018 were calculated, and the national death toll of asthma was estimated as well.The annual percentage change (APC) and average annual percentage change (AAPC) were calculated, and the death rate of asthma among Chinese people aged 0-19 years in 2018 and change trend of asthma mortality from 2008 to 2018 were analyzed.Results:In 2018, there was no significant gender diffe-rence in asthma mortality among Chinese people aged 0-19 years among different age groups, places of residence and geographical regions(all P>0.05). From 2008 to 2018, the mortality rate of people aged 0-19 fluctuated from 0.023/100 000 to 0.046/100 000, the highest mortality rate was in 2009 and 2012, and the lowest was in 2018. It was estimated that the total number of deaths among people aged 0-19 years reached the highest in 2009 (148 cases) and the lowest in 2018 (70 cases). It is estimated that the total number of deaths among people aged 0-19 years in China from 2008 to 2018 was 1 158 cases.From 2008 to 2018, the total mortality rate of asthma in Chinese population aged 0-19 years decreased significantly (AAPC=-7.6%, 95% CI: -10.4%--4.7%). There was a significant decrease in male group(AAPC=-7.4%, 95% CI: -12.5%--2.0%), female group(AAPC=-7.5%, 95% CI: -12.7%--2.0%), 1-<5 years old group(AAPC=-11.4%, 95% CI: -17.9%--4.5%), 15-19 years old group(AAPC=-14.4%, 95% CI: -24.8%--2.6%), rural group(AAPC=-9.0%, 95% CI: -13.1%--4.8%) and central areas(AAPC=-13.1%, 95% CI: -24.0%--0.5%), with statistical significance(all P<0.05). Conclusions:The total mortality of asthma in 0-19-year old population decreased significantly from 2008 to 2018.The mortality rate of asthma in 0-19-year old people in China is at the low level around the world.

Analysis of the characteristics of second primary malignancy affecting the survival of lymphoma patients / 中华肿瘤杂志

Objective@#To analyze the characteristics of the second primary tumor affecting the survival of patients with lymphoma, and to explore the risk factors of death from the second primary tumor.@*Methods@#The medical records and related death information of 1 173 lymphoma patients who had already died with known causes were collected. The basic causes of death and the characteristics of patients who died of the second primary tumor were analyzed. Cox regression model was used to analyze the risk factors of lymphoma patients who died of the second primary tumor.@*Results@#Among the 1 173 patients who had died, 94 (8.0%) died of the second primary tumor, 935 (79.7%) died of the primary lymphoma and 144 (12.3%) died of other diseases. The second primary tumor accounted for 17.5% (38/217) of all causes of death in patients with the survival period of more than 5 years, and the second primary tumor accounted for 28.3% (17/60) of all causes of death in patients with the survival period of more than 10 years. Among 94 cases who died of second primary tumors, 31 died of lung cancer, 15 died of gastric cancer, 13 died of liver cancer, 9 died of pancreatic cancer, 6 died of colorectal cancer, 6 died of second primary lymphoma and 14 died of other types of tumors. Univariate Cox regression analysis showed that age, first-line treatment effect, and chest or mediastinal radiotherapy were associated with the death from second primary tumors for lymphoma patients (all P<0.05). Multivariate Cox regression analysis showed that the effect of first-line treatment (P=0.030) and the chest or mediastinal radiotherapy (P=0.039) were independent factors for the death of lymphoma patients from the second primary tumor.@*Conclusions@#The second primary tumor is an important factor affecting the survival of lymphoma patients, and the risk of death from second primary tumors increases significantly over time. The effect of first-line treatment and radiotherapy in the chest or mediastinum are independent factors for the death of lymphoma patients from the second primary tumor.

Disease burden on uterine fibroids in China, 1990 and 2016 / 中华流行病学杂志

Objective To assess the disease burden on uterine fibroids in China in 1990 and 2016.Methods Data were extracted from the Global Burden of Disease Study 2016.Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016,with key indicators including number of cases,prevalence rates,disability-adjusted life year (DALY) and the rates of DALY.The WHO world standard population,2010-2035 was used to calculate the agestandardized rates.Results In 1990 and 2016,there were 13 695 567 and 27 169 312 women aged 15 years and older,suffered from uterine fibrosis respectively,with prevalence rate as 2.48％ and 4.10％,DALY as 146 045.05 life years and 281 976.67 life years,and the DALY rate as 26.40/100 000 and 42.50/100 000,in 1990 and 2016 respectively.Both the prevalence rate and the DALY rate increased with age,reaching the peak on the 45-49 years-old,in both 1990 and 2016.Women aged 40-54 years accounted for 55.60％ (1990) and 66.74％ (2016) of the total cases while 48.37％ (1990) and 60.65％ (2016) of the total DALY.The first three provinces with highest DALYs were Shandong (1990:12 574.67 life year;2016:22 728.12 life year),Henan (1990:10 849.29 life year;2016:18 454.32 life year) and Jiangsu (1990:10 501.55 life year;2016:18 274.10 life year),while the three provinces with leading standardized DALY rates were Heilongjiang (1990:48.20/100 000;2016:47.00/100 000),Shanxi (1990:44.50/100 000;2016:47.70/100 000) and Tianjin (1990:43.80/100 000;2016:46.40/100 000) in both 1990 and 2016.Compared with 1990,the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as:98.38％),standardized prevalence rate increased by 1.88％,DALY value increased by 135 931.62 life years (with the rate of change as 93.08％) and standardized DALY rate increased by 5.92％ among Chinese women,in 2016.Conclusion Menopausal women were the ones hard hit by uterine fibrosis.Compared with data from 1990,the disease burden of uterine fibrosis increased rapidly in China,in 2016.

Association between high air temperature and mortality in summer: A multi-city analysis in China / 中华流行病学杂志

Objective To understand the associations between changes of high air temperature and mortality in summer in 31 cities in China.Methods Daily mortality and meteorological data in 31 cities in China from January 1,2008 to December 31,2013 were collected.Distributed lag nonlinear model was used to evaluate the association between high air temperature change and mortality in early summer and late summer after controlling for the long-term trend and the effect of "day of week".Results The relative risk of high air temperature on mortality was higher in early summer,with relative risk in the range of 1.08-2.14 in early summer and 1.03-1.67 in late summer.In early summer,the influence of high temperature on mortality was mainly below 5th of percentile and above 50th of percentile,while in late summer it was mainly above 95th of percentile.The lag effect of high air temperature on mortality in early summer was 6 days,while the lag effect in late summer was only about 2 days.Conclusions Association existed between high air temperature and mortality.The influence of high air temperature on mortality in early summer was stronger than that in late summer.It is necessary to take targeted protection measures.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016.Methods Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI.Measurements for attributable BOD of diabetes included disability adjusted life years (DALY),years of lost life (YLL),years living with disability (YLD),death number and mortality rate.The average world population from 2010 to 2035 was used as a reference.Results In 2016,death number of diabetes attributable to high BMI was 40 310,which was significantly higher than that in 1990 (15 008).Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016,which showed a more significant increasing trend in both males and people aged 15-49 years.DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years.YLL and YLD also showed increasing trends.The highest increasing rate of YLD was in people aged 15-49 years.High BMI was responsible for 26.01％ of the diabetes deaths in 2016 in China,an increase of 39.39％ compared with that in 1990 (18.66％).Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016.Inner Mongolia,Xinjiang,Zhejiang,Macao SAR,Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period.Conclusions There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI,causing a heavy disease burden,in China from 1990 to 2016.The BOD varied in both different age and gender groups.More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Disease burden on uterine fibroids in China, 1990 and 2016 / 中华流行病学杂志

Objective To assess the disease burden on uterine fibroids in China in 1990 and 2016.Methods Data were extracted from the Global Burden of Disease Study 2016.Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016,with key indicators including number of cases,prevalence rates,disability-adjusted life year (DALY) and the rates of DALY.The WHO world standard population,2010-2035 was used to calculate the agestandardized rates.Results In 1990 and 2016,there were 13 695 567 and 27 169 312 women aged 15 years and older,suffered from uterine fibrosis respectively,with prevalence rate as 2.48％ and 4.10％,DALY as 146 045.05 life years and 281 976.67 life years,and the DALY rate as 26.40/100 000 and 42.50/100 000,in 1990 and 2016 respectively.Both the prevalence rate and the DALY rate increased with age,reaching the peak on the 45-49 years-old,in both 1990 and 2016.Women aged 40-54 years accounted for 55.60％ (1990) and 66.74％ (2016) of the total cases while 48.37％ (1990) and 60.65％ (2016) of the total DALY.The first three provinces with highest DALYs were Shandong (1990:12 574.67 life year;2016:22 728.12 life year),Henan (1990:10 849.29 life year;2016:18 454.32 life year) and Jiangsu (1990:10 501.55 life year;2016:18 274.10 life year),while the three provinces with leading standardized DALY rates were Heilongjiang (1990:48.20/100 000;2016:47.00/100 000),Shanxi (1990:44.50/100 000;2016:47.70/100 000) and Tianjin (1990:43.80/100 000;2016:46.40/100 000) in both 1990 and 2016.Compared with 1990,the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as:98.38％),standardized prevalence rate increased by 1.88％,DALY value increased by 135 931.62 life years (with the rate of change as 93.08％) and standardized DALY rate increased by 5.92％ among Chinese women,in 2016.Conclusion Menopausal women were the ones hard hit by uterine fibrosis.Compared with data from 1990,the disease burden of uterine fibrosis increased rapidly in China,in 2016.

Association between high air temperature and mortality in summer: A multi-city analysis in China / 中华流行病学杂志

Objective To understand the associations between changes of high air temperature and mortality in summer in 31 cities in China.Methods Daily mortality and meteorological data in 31 cities in China from January 1,2008 to December 31,2013 were collected.Distributed lag nonlinear model was used to evaluate the association between high air temperature change and mortality in early summer and late summer after controlling for the long-term trend and the effect of "day of week".Results The relative risk of high air temperature on mortality was higher in early summer,with relative risk in the range of 1.08-2.14 in early summer and 1.03-1.67 in late summer.In early summer,the influence of high temperature on mortality was mainly below 5th of percentile and above 50th of percentile,while in late summer it was mainly above 95th of percentile.The lag effect of high air temperature on mortality in early summer was 6 days,while the lag effect in late summer was only about 2 days.Conclusions Association existed between high air temperature and mortality.The influence of high air temperature on mortality in early summer was stronger than that in late summer.It is necessary to take targeted protection measures.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016.Methods Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI.Measurements for attributable BOD of diabetes included disability adjusted life years (DALY),years of lost life (YLL),years living with disability (YLD),death number and mortality rate.The average world population from 2010 to 2035 was used as a reference.Results In 2016,death number of diabetes attributable to high BMI was 40 310,which was significantly higher than that in 1990 (15 008).Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016,which showed a more significant increasing trend in both males and people aged 15-49 years.DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years.YLL and YLD also showed increasing trends.The highest increasing rate of YLD was in people aged 15-49 years.High BMI was responsible for 26.01％ of the diabetes deaths in 2016 in China,an increase of 39.39％ compared with that in 1990 (18.66％).Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016.Inner Mongolia,Xinjiang,Zhejiang,Macao SAR,Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period.Conclusions There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI,causing a heavy disease burden,in China from 1990 to 2016.The BOD varied in both different age and gender groups.More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Causes of death in 1,173 patients with lymphoma / 中国肿瘤临床

Objective: To understand the causes of death and long-term prognosis of lymphoma patients. Methods: Data from 6 200 patients with lymphoma admitted to the Department of Lymphoma, Peking University Cancer Hospital, from January 1995 to Decem-ber 2017, were collected. Those who had died and whose causes of death were known were selected. Clinical records and information on death were collected. Results: A total of 1,173 patients were selected, 742 of whom were male (63.3% ), and 431 were female (36.7%). The median age was 56 (8-92) years. There were 77 cases (6.6%) of Hodgkin's lymphoma, 1,095 cases (93.4%) of non-Hodg-kin's lymphoma, and 1 case of unclear pathological classification. Overall population survival was 0-253 months, with a median surviv-al rate of 20 months. The direct causes of death included lymphoma in 688 (58.7%), various infectious diseases in 119 (10.1%), cardio-vascular diseases in 96 (8.2%), secondary primary tumors in 68 (5.8%), and other diseases in 202 cases (17.2%). The underlying causes of death included lymphoma in 936 (79.8%), secondary primary tumors in 94 (8.0%), cardiovascular diseases in 75 (6.4%), respiratory diseases in 32 (2.7%) and other diseases in 36 cases (3.1%). The underlying causes of death in cases wherein survival time exceeded 5 years included lymphoma in 129 (59.4%), secondary primary tumors in 38 (17.5%), cardiovascular diseases in 35 (16.1%), and other dis-eases in 15 cases (6.9%). The underlying causes of death in cases wherein survival time exceeded 10 years included lymphoma in 28 (46.7%), secondary primary tumors in 17 (28.3%), cardiovascular diseases in 7 (11.7%), and other diseases in 8 cases (13.3%). Conclu-sions: Primary tumors remain the main cause of death in patients with lymphoma. After primary tumors, secondary primary tumors and cardiovascular diseases are the most common causes of death, and with the prolongation of survival, the risk of death caused by these factors increases significantly.

The disease burden of pancreatic cancer in China in 1990 and 2017 / 中华流行病学杂志

Objective@#To analyze the disease burden of pancreatic cancer in China in 1990 and 2017.@*Methods@#Province-specific data in China from the Global Burden of Disease Study (GBD) 2017 were used to describe the change of death status, disease burden of pancreatic cancer in Chinese population by specific province and age groups, including incidence, mortality, disability-adjusted life years (DALY), years of life lost (YLL) due to premature mortality and years lived with disability (YLD) in 1990 and 2017. Meanwhile the incidence, mortality, DALY rate, YLL rate, YLD rate were standardized by the GBD global standard population in 2017.@*Results@#In 2017, the new cases of pancreatic cancer, incidence and age-standardized incidence accounted for 83.6 thousand, 5.92/100 000 and 4.37/100 000 in China, with an increase of 230.94%, 180.45% and 49.88% compared with 1990, respectively. The total number of deaths, mortality and age-standardized mortality appeared as 85.1 thousand, 6.02/100 000, 4.48/100 000, with an increase of 236.08%, 184.80% and 47.51% respectively. The incidence and mortality of pancreatic cancer increased with age and accelerated from the age of 55 to 59 both in 1990 and 2017. The highest incidence and mortality showed in 85-89 years old in 2017 and in 90-94 years old in 1990. The standardized DALY rate of pancreatic cancer increased from 71.00/100 000 in 1990 to 94.32/100 000 in 2017, increased by 32.84%. The standardized YLL rate increased from 70.39/100 000 to 93.42/100 000, increased by 32.72%. The standardized YLD rate increased from 0.62/100 000 to 0.90/100 000, increased by 45.80%. In terms of age distribution, DALY rate, YLL rate and YLD rate of pancreatic cancer basically showed an increasing trend with age in 1990 and 2017. In 2017, Jiangsu (7.61/100 000), Shanghai (7.52/100 000) and Liaoning (6.84/100 000) ranked the top three provinces in terms of standardized mortality. Compared with 1990, Henan (104.28%), Sichuan (94.02%) and Hebei (90.39%) saw the fastest increase in standardized mortality.@*Conclusions@#The incidence, mortality and disease burden of pancreatic cancer in China increased significantly from 1990 to 2017. Prevention and control measures should be strengthened to reduce the disease burden of pancreatic cancer.

The definition of heat-wave based on mortality risk assessment in different regions of China / 中华预防医学杂志

Objective@#To identify the definition of heat wave based on mortality risk assessment in different regions of China.@*Methods@#Daily mortality (from China Information System for Disease Control and Prevention) and meteorological data (from National Meteorological Information Center in China) from 66 counties with a population of over 200 000 were collected from 2006-2011. With the consideration of climate type and administrative division, China was classified as seven regions. Firstly, distributed lag non-linear model (DLNM) was used to estimate community-specific effects of temperature on non-accidental mortality. Secondly, a multivariate meta-analysis was applied to pool the estimates of community-specific effects to explore the region-specific temperature threshold and the duration for definition of heat wave.@*Results@#We defined regional heat wave of Northeast, North, Northwest, East, Central and Southwest China as being two or more consecutive days with daily mean temperature higher than or equal to the P64, P71, P85, P67, P75 and P77 of warm season (May to October) temperature, respectively, while the thresholds of temperature were 21.6, 23.7, 24.3, 25.7, 28.0 and 25.3 ℃. The heat wave in South China was defined as five or more consecutive days with daily mean temperature higher than or equal to the P93 (30.4 ℃) of warm season (May to October) temperature.@*Conclusion@#The region-specific definition of heat wave developed in our study may provide local government with the guidance of establishment and implementation of early heat-health response systems to address the negative health outcomes due to heat wave.

Lung cancer deaths attributable to ambient PM2.5 exposure in 2016 in China / 中华预防医学杂志

Objective@#To analyze the lung cancer deaths attributable to ambient PM2.5 exposure in China in 2016.@*Methods@#All data were from the Global Burden of Disease Study 2016 (GBD 2016). Multiple-source data, including satellite observation, ground measurement, chemical migration model simulation, etc., and the data integration model for air quality (DIMAQ) were used to estimate the grid-level exposure to ambient PM2.5. Data from the vital registry and cancer registry were used to establish statistical model to estimate the lung cancer deaths by province, age and gender. The lung cancer deaths attributable to PM2.5 were calculated based on the calculation of population attributable fraction (PAF). The GBD world population age structure was adopted to calculate age-standardized rates for comparison among provinces (including 31 provinces, autonomous regions and municipalities directly under the central government, as well as Hong Kong and Macao special administrative regions, excluding Taiwan of China).@*Results@#In 2016, the lung cancer deaths attributable to ambient PM2.5 exposure in China were 14.56×104 (95% uncertainty interval (UI): 9.63×104-19.55×104), accounting for 24.66% (95%UI: 16.38%-33.12%) of total lung cancer deaths. The lung cancer death rate attributable to PM2.5 increased with age, with the lowest among 25-29 age group (0.25/105, 95%UI: 0.17/105-0.34/105), the highest among ≥80 age group (90.70/105, 95%UI: 59.85/105-122.20/105). The lung cancer death rate attributable to PM2.5 among males (14.84/105, 95%UI: 9.78/105-19.93/105) was higher than that in females (6.21/105, 95%UI: 4.07/105-8.40/105). The age-standardized death rates (ASDR) of lung cancer attributable to PM2.5 among males and females in China were higher than the global average level. The attributable ASDR of lung cancer varied among provinces, highest in Shandong (13.51/105, 95%UI: 9.14/105-18.20/105) and lowest in Tibet (0.85/105, 95%UI: 0.44/105-1.51/105).@*Conclusion@#In 2016, the lung cancer deaths attributable to ambient PM2.5 exposure in China was heavy, and varied in different age groups, genders and provinces.

Study of the prevalence and disease burden of chronic disease in the elderly in China / 中华流行病学杂志

Objective@#To understand the prevalence and disease burden of major chronic diseases in the elderly in China and provide scientific basis for the prevention and control of chronic diseases and for the rational allocation of health resources.@*Methods@#We analyzed the prevalence of chronic diseases in residents aged ≥60 years in China by using national and provincial surveillance data of chronic diseases and related risk factors in China. We conducted the analysis on the burden of chronic diseases in the elderly in China by using the data of global burden of disease.@*Results@#The prevalence rates of hypertension, diabetes and hypercholesterolemia were 58.3%, 19.4% and 10.5% respectively in residents aged ≥60 years in China. Up to 75.8% of the residents aged ≥60 years had at least one chronic disease. The prevalence rate was higher in women than in men, higher in urban area than in rural area. With the increase of age, the prevalence rate of chronic diseases also increased. The top three chronic diseases with heavy disease burden in residents aged ≥70 years were stroke, myocardial infarction, cancer and chronic obstructive pulmonary disease.@*Conclusion@#The prevalence of major chronic diseases in the elderly is high with three quarters of the elderly suffering from at least one chronic disease, and the burden of chronic diseases is increasing.

Deaths attributed to ambient air pollution in China between 2006 and 2016 / 中华流行病学杂志

Objective To analyze the deaths attributed to ambient air pollution in China between 2006 and 2016.Methods The data were collected from the project of Global Burden of Disease in 2016 (GBD2016).The Data Integration Model for Air Quality were used to estimate exposure to particulate matter smaller than 2.5 μm in aerodynamic diameter (PM2.5).The attributable death number was calculated based on the calculation of population attributable fraction (PAF),and the results were compared by gender,diseases and provinces.An average world population age structure was adopted to calculate age-standardized rates.Results In 2016,a total of 1 075 000 deaths attributed to ambient air pollution occurred in China,accounting for 11.1％ of the total deaths,and 57.6％ of the deaths attributed to ambient air pollution were due to ischemic heart disease and stroke.The death number among men was 1.7 times higher than that in women,Compared with 2006,the proportion of ambient air pollution related deaths in total deaths decreased by 6.8％;the agestandardized death rate attributed to ambient air pollution decreased by 26.5％ and the decrease rate of lower respiratory infections (37.6％) and chronic obstructive pulmonary disease (42.1％) were greater than ischemic heart disease (5.3％).The age-standardized rate of death attributed to ambient air pollution decreased both in men and in women,but the decrease rate was higher in women (34.8％) than that in men (20.4％).The PAFs varied among provinces,it was highest in Tianjin (13.9％),lowest in Tibet (6.1％),and it was relatively higher in Beijing,Hebei,Shandong,Henan and the three provinces in the northeast and relatively lower in Hong Kong,Macao,Fujian and Hainan etc..The agestandardized rate of death attributed to ambient air pollution was highest in Xinjiang (120.1/100 000) and lowest in Hong Kong (30.9/100 000),and it was relatively higher in Qinghai,Guizhou,Henan and relatively lower in Macao,Shanghai and Fujian,etc..Compared with 2006,the PAFs of 17 provinces decreased,the decrease rate ranged from 4.1％ to 16.8％,whereas the PAF of Jilin (5.0％) and Heilongjiang (8.1％) increased,and the PAFs of other 14 provinces showed no significant change.The attributable age-standardized death rate decreased in all provinces with the decrease rate ranging from 11.9％ (Heilongjiang) to 43.2％ (Fujian),and the decrease rate was relatively higher in Guangdong,Zhejiang and Guizhou,and lower in the three provinces in the northeast,Hubei and Hebei etc.Conclusions In 2016,the disease burden attributable to PM2.5 in China was heavy,but mitigated compared with 2006.The gender and area specific distributions of deaths attributed to ambient air pollution were observed.

An observational study of high air temperature on diabetes mortality in six cities in China / 中华流行病学杂志

Objective To evaluate the effect of high air temperature on diabetes mortality in six cities in China.Methods Daily diabetes mortality and meteorological data were collected from January 1,2008 to December 31,2013 in Beijing,Tianjin,Shanghai,Chongqing,Guangzhou,and Shenyang.Distributed lag nonlinear model was used to evaluate the association between high air temperature and diabetes mortality after controlling for the long-term trend and the effect of "day of week".Results The effect of high air temperature on diabetes mortality varied in different cities,the maximum cumulative relative risk of Beijing,Tianjin,Shanghai,Chongqing,Guangzhou and Shenyang were 1.37 (lag 2 days),1.32 (lag 0 days),1.40 (lag 0 days),1.26 (lag 2 days),1.48 (lag 2 days) and 1.67 (lag 3 days).The daily diabetes death numbers were similar in men and women,but the death number in women were slightly higher than that in men,no gender specific characteristics were found.The death number was highest in age group 65-84 years,accounting for ＞60％ of the total deaths,the difference was significant.Conclusion The mortality of diabetes increased obviously in the context of high air temperature environment.

Deaths attributable to alcohol use and its impact on life expectancy in China, 2013 / 中华流行病学杂志

Objective To analyze the deaths attributable to alcohol use and its impact on people's life expectancy in China in 2013.Methods The mortality data from the Disease Surveillance Points System and alcohol use data from China Chronic Disease Surveillance (2013) were used.The deaths attributed to alcohol use and its impact on the life expectancy of Chinese residents were estimated based on the principle of comparative risk assessment by calculating population attributable fraction.Results In 2013,alcohol use resulted in 381 200 deaths,including 97 100 hemorrhagic stroke deaths,88 200 liver cancer deaths,61 400 liver cirrhosis deaths and 48 700 esophageal cancer deaths,and prevented 76 500 deaths,including 68 500,4 900 and 3 100 deaths which might be caused by ischemic heart disease,hemorrhagic stroke and diabetes respectively.If risk factor of alcohol use is removed,the people's life expectancy would rise by an average of 0.43 years,especially in westem China by 0.52 years,which was 0.12 years higher than that in eastern and central China,and the life expectancy of the population in rural and urban areas would rise by 0.48 years and 0.31 years respectively.Conclusions Although alcohol has a protective effect on reducing ischemic heart disease,stroke and diabetes deaths,alcohol use is still a risk factor influencing the mortality and life expectancy of residents in China.It is necessary to take targeted measures to reduce the health problems caused by harmful use of alcohol.

Deaths attributed to ambient air pollution in China between 2006 and 2016 / 中华流行病学杂志

Objective To analyze the deaths attributed to ambient air pollution in China between 2006 and 2016.Methods The data were collected from the project of Global Burden of Disease in 2016 (GBD2016).The Data Integration Model for Air Quality were used to estimate exposure to particulate matter smaller than 2.5 μm in aerodynamic diameter (PM2.5).The attributable death number was calculated based on the calculation of population attributable fraction (PAF),and the results were compared by gender,diseases and provinces.An average world population age structure was adopted to calculate age-standardized rates.Results In 2016,a total of 1 075 000 deaths attributed to ambient air pollution occurred in China,accounting for 11.1％ of the total deaths,and 57.6％ of the deaths attributed to ambient air pollution were due to ischemic heart disease and stroke.The death number among men was 1.7 times higher than that in women,Compared with 2006,the proportion of ambient air pollution related deaths in total deaths decreased by 6.8％;the agestandardized death rate attributed to ambient air pollution decreased by 26.5％ and the decrease rate of lower respiratory infections (37.6％) and chronic obstructive pulmonary disease (42.1％) were greater than ischemic heart disease (5.3％).The age-standardized rate of death attributed to ambient air pollution decreased both in men and in women,but the decrease rate was higher in women (34.8％) than that in men (20.4％).The PAFs varied among provinces,it was highest in Tianjin (13.9％),lowest in Tibet (6.1％),and it was relatively higher in Beijing,Hebei,Shandong,Henan and the three provinces in the northeast and relatively lower in Hong Kong,Macao,Fujian and Hainan etc..The agestandardized rate of death attributed to ambient air pollution was highest in Xinjiang (120.1/100 000) and lowest in Hong Kong (30.9/100 000),and it was relatively higher in Qinghai,Guizhou,Henan and relatively lower in Macao,Shanghai and Fujian,etc..Compared with 2006,the PAFs of 17 provinces decreased,the decrease rate ranged from 4.1％ to 16.8％,whereas the PAF of Jilin (5.0％) and Heilongjiang (8.1％) increased,and the PAFs of other 14 provinces showed no significant change.The attributable age-standardized death rate decreased in all provinces with the decrease rate ranging from 11.9％ (Heilongjiang) to 43.2％ (Fujian),and the decrease rate was relatively higher in Guangdong,Zhejiang and Guizhou,and lower in the three provinces in the northeast,Hubei and Hebei etc.Conclusions In 2016,the disease burden attributable to PM2.5 in China was heavy,but mitigated compared with 2006.The gender and area specific distributions of deaths attributed to ambient air pollution were observed.

An observational study of high air temperature on diabetes mortality in six cities in China / 中华流行病学杂志

Objective To evaluate the effect of high air temperature on diabetes mortality in six cities in China.Methods Daily diabetes mortality and meteorological data were collected from January 1,2008 to December 31,2013 in Beijing,Tianjin,Shanghai,Chongqing,Guangzhou,and Shenyang.Distributed lag nonlinear model was used to evaluate the association between high air temperature and diabetes mortality after controlling for the long-term trend and the effect of "day of week".Results The effect of high air temperature on diabetes mortality varied in different cities,the maximum cumulative relative risk of Beijing,Tianjin,Shanghai,Chongqing,Guangzhou and Shenyang were 1.37 (lag 2 days),1.32 (lag 0 days),1.40 (lag 0 days),1.26 (lag 2 days),1.48 (lag 2 days) and 1.67 (lag 3 days).The daily diabetes death numbers were similar in men and women,but the death number in women were slightly higher than that in men,no gender specific characteristics were found.The death number was highest in age group 65-84 years,accounting for ＞60％ of the total deaths,the difference was significant.Conclusion The mortality of diabetes increased obviously in the context of high air temperature environment.