Analysis on trend of health examination rate and influencing factors in adults in China, 2010-2018 / 中华流行病学杂志

Objective: To understand the health examination rate and its changing trend in adults in China from 2010 to 2018, identify the main factors affecting the health examination rate and provide data support for decision making of health intervention. Methods: Data from China Chronic Disease and Risk Factor Surveillance in 2010, 2013, 2015 and 2018 were used. After complex weighting of the data, the rates of health examination, its changing trends and reasons for receiving health examination in adults were analyzed. Average annual percent change (AAPC) was used to describe the changing trend. Anderson model was used as the analysis framework. Multivariate logistic regression model was used to identify the influencing factors for the health examination rate. Results: From 2010 to 2018, the health examination rate in adults increased from 28.2% (95%CI: 24.8%-31.6%) to 41.0% (95%CI: 38.9%-43.1%, P for trend <0.001), the AAPC was 5.47%, the annual average increase was more obvious in those with lower education level and lower income level and in those living in rural area and in western China. In 2018, people received health examination mainly due to providing without charge by community (36.7%) and working unit (28.5%). The results of multivariate analysis showed that being women, age ≥45 years, education level of junior high school or above, living in urban areas, medical insurance, annual income ≥24 000 RMB, suffering from multiple chronic diseases, non-smoking, drinking, adequate physical activity were positive factors for receiving health examination. Conclusion: The rate of health examination in adults increased in China during 2010-2018, and the main reason for receiving health examination is free of charge.

Cardiovascular health status of Chinese adults based on "Life's Essential 8" score / 中华流行病学杂志

Objective: To assess the cardiovascular health status of adults in China by using the "Life's Essential 8" score, and provide reference for the development and improvement of cardiovascular disease prevention and control policies and measures. Methods: Chronic Disease and Nutrition Surveillance was conducted in 298 counties/districts in 2015 in 31 provinces (autonomous regions, municipalities) across China, multi-stage stratified cluster random sampling was used to select 45 households in each village or neighborhood, and 20 households were further selected to conduct dietary surveys. In this study, a total of 70 093 adults aged ≥20 years who completed the dietary survey and had complete information were included, their cardiovascular health status were assessed by using the "Life's Essential 8" score, a cardiovascular health scoring standard released by the American Heart Association in 2022. All results were adjusted using complex design-based sampling weights to achieve a better estimate of the population. Results: In 2015, the overall cardiovascular health score of Chinese adults aged ≥20 years was 73.3±12.6, the score was significantly higher in women (77.9±11.6) than in men (68.7±11.8), and higher in urban area (74.5±12.8) than in rural area (71.9±12.2), the differences were significant (P<0.001). It was estimated that about 0.25% (95%CI: 0.16%-0.33%) of adults in China had cardiovascular health score of 100, and 33.0% (95%CI: 31.6%-34.3%), 63.2% (95%CI: 62.1%-64.3%), and 3.9% (95%CI: 3.5%-4.2%) of adults had high, moderate and low cardiovascular health scores, respectively. The proportion of those with high cardiovascular health scores was relatively low in men, those with low education level, those with low income, those living in rural areas, and those living in southwest China (P<0.001). Of the eight factors, diet had the lowest mean score (46.0, 95%CI: 44.7-47.3), followed by blood pressure (59.4, 95%CI: 58.2-60.6) and tobacco exposure (61.4, 95%CI: 60.6-62.2). Conclusions: The cardiovascular health status of two-thirds of adult population in China needs to be improved. Diet, tobacco exposure, and blood pressure are the factors affecting the cardiovascular health of Chinese population, to which close attention needs to be paid, and men, rural residents, and those with lower socioeconomic status are key groups in cardiovascular health promotion.

Associations between glycated hemoglobin and glucose indicators in adults in areas at different altitude in China / 中华流行病学杂志

Objective: To explore the associations of glycated hemoglobin (HbA1c) with FPG and oral glucose tolerance test 2-hour (OGTT-2 h) in areas at different altitude in China. Methods: Subjects who participated in 2018-2019 China Chronic Disease and Risk Factor Surveillance and had no prior type 2 diabetes diagnosis were included. Subsequently, they were categorized into three groups based on altitude of living area (<2 000, 2 000- and ≥3 000 m). With adjustment for intracluster correlation, multivariable linear regression analysis was performed to evaluate the associations of HbA1c with FPG and OGTT-2 h in the context of HbA1c was normal (<5.7%) or abnormal (≥5.7%). Furthermore, the shape of relationships between HbA1c and glucose indicators was examined using restricted cubic spline. Finally, receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA1c for diabetes. Results: A total of 157 277 subjects were included in the analysis. While FPG and OGTT-2 h levels gradually decreased with increase of altitude, HbA1c level was similar among the three groups. When HbA1c was <5.7%, its association with FPG and OGTT-2 h was weak and no obvious difference was observed among the three groups. When HbA1c was ≥5.7%, the FPG and OGTT-2 h increased by 15.45% (95%CI:14.71%- 16.18%) and 24.54% (95%CI:23.18%-25.91%) respectively per one standard deviation increase in HbA1c in group in area at altitude <2 000 m. However, the FPG and OGTT-2 h increased by 13.08% (95%CI:10.46%-15.76%) and 21.72% (95%CI:16.39%-27.31%), respectively, in group in area at altitude 2 000- m, and increased by 11.41% (95%CI:9.32%-13.53%) and 20.03% (95%CI:15.38%- 24.86%), respectively, in group of altitude ≥3 000 m. The restricted cubic spline indicated that the curve showing the association of HbA1c with FPG and OGTT-2 h was flat when HbA1c was <5.7%, but showed a positive linear relationship when HbA1c was ≥5.7%. The area under curve for detecting diabetes was 0.808 (95%CI:0.803-0.812) in group of altitude <2 000 m and 0.728 (95%CI:0.660-0.796, P=0.022) in group of altitude ≥3 000 m. The relevant optimal cutoff value of HbA1c was 5.7%, with a sensitivity of 65.4% and a specificity of 83.0%, and 6.0%, with a sensitivity of 48.3% and a specificity of 93.7%, respectively. Conclusions: When HbA1c was ≥5.7%, the association between HbA1c and glucose indicators became weaker as the increase of altitude. In the area at altitude ≥3 000 m, it may not be appropriate to use HbA1c in the diagnosis of diabetes.

Geographic Variations in the Prevalence, Awareness, Treatment, and Control of Dyslipidemia among Chinese Adults in 2018-2019: A Cross-sectional Study / 生物医学与环境科学（英文）

OBJECTIVE@#To investigate the spatial patterns of the prevalence, awareness, treatment, and control rates of dyslipidemia at the provincial level in China.@*METHODS@#A national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in mainland China in 2018-2019, using a multi-stage, stratified, cluster-randomized sampling design. Subjects, as households, were selected, followed by a home visit to collect information. Both descriptive and linear regression procedures were applied in the analyses.@*RESULTS@#The overall prevalence of dyslipidemia was 35.6%, and wide geographic variations of prevalence, treatment, and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1 ± 13.8 years. The highest-lowest difference regarding the provincial level prevalence rates were 19.7% vs. 2.1% for high low-density lipoprotein cholesterol, 16.7% vs. 2.5% for high total cholesterol, 35.9% vs. 5.4% for high triglycerides, and 31.4% vs. 10.5% for low high-density lipoprotein cholesterol. The treatment rate of dyslipidemia was correlated with the socio-demographic index ( P < 0.001), urbanization rate ( P = 0.01), and affordable basic technologies and essential medicines ( P < 0.001).@*CONCLUSION@#Prevailing dyslipidemia among the Chinese population and its wide geographic variations in prevalence, treatment, and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.

Hypertension Prevalence, Awareness, Treatment, and Control and Their Associated Socioeconomic Factors in China: A Spatial Analysis of A National Representative Survey / 生物医学与环境科学（英文）

Objective@#We aimed to investigate and interpret the associations between socioeconomic factors and the prevalence, awareness, treatment, and control of hypertension at the provincial level in China.@*Methods@#A nationally and provincially representative sample of 179,059 adults from the China Chronic Disease and Nutrition Surveillance study in 2015-2016 was used to estimate hypertension burden. The spatial Durbin error model was fitted to investigate socioeconomic factors associated with hypertension indicators.@*Results@#Overall, it was estimated that 29.20% of the participants were hypertensive nationwide, among whom, 34.32% were aware of their condition, 27.69% had received antihypertensive treatment, and 7.81% had controlled their condition. Per capita gross domestic product (GDP) was associated with hypertension prevalence (coefficient: -2.95, 95% @*Conclusion@#Hypertension indicators were not only directly influenced by socioeconomic factors of local area but also indirectly affected by characteristics of geographical neighbors. Population-level strategies should involve optimizing supportive socioeconomic environment by integrating clinical care and public health services to decrease hypertension burden.

Underestimation of weight status among overweight and obese adults in China in 2013 / 中华疾病控制杂志

Objective The aim is to understand the underestimation of body weight status and its associated factors among overweight and obese adults in China. Methods Nationally representative data were collected in 2013 by the China Chronic Disease and Risk Factor Surveillance which used a multistage stratified cluster sampling method. A total of 87 552 overweight and obese adults aged ≥18 years old were included. Demographic characteristics, weight perception and disease status were obtained from in-person interviews. Height, weight and blood pressure were measured through physical examination. Venous blood samples were obtained and assayed for fasting plasma glucose, 2-hour oral glucose tolerance test, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Complex sampling was weighted and multiple logistic regression models were used for analyzing. Results Among overweight and obese adults, 74.7% (95% CI: 73.3%-76.1%) underestimated their weight status. The mild underestimation rate was 60.7% (59.6%-61.7%) while the severe was 14.0% (13.1%-14.9%). The aged, low education level, low annual income, rural area and obesity were risk factors for both weight status underestimation and severe underestimation (all P<0.05). Awareness of having hypertension and dyslipidemia were protective factors (all P<0.05). Conclusions Most overweight and obese adults in China underestimated their own weight status, which was affected by age, education and income level, awareness of having chronic diseases and other factors. Targeted interventions should be carried out for different characteristic groups.

Prediction of 10-year Atherosclerotic Cardiovascular Disease Risk among Adults Aged 40-79 Years in China: a Nationally Representative Survey / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To establish the distribution of 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Chinese adults.</p><p><b>METHODS</b>We estimated the 10-year ASCVD risk by applying the 2013 American College of Cardiology/ American Heart Association pooled cohort equations (PCEs) to the data obtained from the 2010 China Chronic Disease and Risk Factor Surveillance that involved 61,541 participants (representing 520,158,652 Chinese adults) aged 40-79 years. We also compared the ASCVD risk with the 10-year ischemic cardiovascular disease (ICVD) risk, which was calculated using the simplified scoring tables recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases (Chinese model).</p><p><b>RESULTS</b>Based on the PCEs, the average 10-year ASCVD risk among adults without self-reported stroke or myocardial infraction was 12.5%. Approximately 247 million (47.4%) and 107 million (20.6%) adults had ⋝ 7.5% and > 20% 10-year ASCVD risks, respectively. The 10-year ASCVD risk > 20% was higher among men, less educated individuals, smokers, drinkers, and physically inactive individuals than among their counterparts. Overall, 29.0% of adults categorized using the Chinese model were overclassified with the PCEs.</p><p><b>CONCLUSION</b>Our results define the distribution of 10-year ASCVD risk among Chinese adults. The 10-year ASCVD risk predicted by the PCEs was higher than the ICVD risk predicted by the Chinese model.</p>

Vegetable and Fruit Consumption among Chinese Adults and Associated Factors: A Nationally Representative Study of 170,847 Adults / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>This study examined vegetable and fruit (VF) consumption rate and its associated factors among Chinese adults.</p><p><b>METHODS</b>Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors (e.g., meal frequency and physical activity) were examined through logistic regression analysis.</p><p><b>RESULTS</b>The average fruit consumption was 102.3 g/day (95% CI: 97.0-107.6) and the average vegetable consumption was 350.6 g/day (95% CI: 339.3-361.8). Over half (53.2%, 95% CI: 50.9-55.4) of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization (WHO). Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% (95% CI: 46.2%-52.2%) vs. 44.0% (95% CI: 41.7%-46.3%) P < 0.01]. Old age (OR = 1.01, 95% CI: 1.00-1.01), low educational level, low income, minority ethnicity (OR = 1.41, 95% CI: 1.15-1.74), underweight (OR = 1.17, 95% CI: 1.03-1.33), single marital status (OR = 1.20, 95% CI: 1.08-1.33), low health literacy, irregular breakfast (OR = 1.20, 95% CI: 1.04-1.38) or lunch (OR = 1.58, 95% CI: 1.26-1.99) habits, and no leisure-time physical activity were associated with low VF consumption.</p><p><b>CONCLUSION</b>Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.</p>

Survey on current status of cognitive function among Chinese elderly people / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the current status and distribution features of cognitive function among the elderly population of China.</p><p><b>METHODS</b>A total of 18 137 subjects aged over 60 years old from 2010 Chronic Non-communicable Disease & Risk Factor Surveillance in China were selected in this study. Questionnaire was used to collect the information about gender, age and health status. The Mini-Mental State Examination (MMSE) was adopted as an instrument to measure the cognitive function of adult who had self-reported memory decline. After performing complex weighted analysis, the current status of cognitive function and the prevalence of cognitive disorder were compared by different genders, age groups, urban/rural and education levels.</p><p><b>RESULTS</b>Among the 18 086 subjects, the median of MMSE sore was 23. The score was higher in males (25) than in females (22) and it was higher in urban (25) than in rural area (22). The cognitive function declined with age increasing. The group of people aging 60-64 years old had the highest score (26), and the group of people aging ≥ 80 years old had the lowest score (19). The MMSE score rose up with education level increasing, the group of people with education level above middle school had the highest score (28) and the group of illiterate people had the lowest score (20). The prevalence of overall cognitive disorder was 10.12% (95%CI: 8.22%-12.02%). The female prevalence (12.45%, 95%CI:9.95%-14.94%) was higher than male prevalence (7.68%, 95%CI:5.94%-9.43%). The group of people aged 60-64 years old had the lowest prevalence (4.69%, 95%CI:3.40%-5.98%), and the people aged ≥ 80 years old had the highest prevalence (22.43%, 95%CI:17.80%-27.05%). The prevalence increased with age increasing (χ(2) = 320.02, P < 0.01). The prevalence of cognitive disorder in illiterate group was 14.6% (95%CI:12.01%-17.23%), and it was separately 6.92% (95%CI: 5.21%-8.64%) and 3.99% (95%CI: 2.58%-5.40%) in group of people with education background of primary school and middle school. The prevalence decreased with education levels increasing (χ(2) = 156.49, P < 0.01). Married or cohabiting elderly people had the lowest prevalence (8.51%, 95%CI: 6.58%-10.43%), lower than single ones (9.32%, 95%CI: 4.00%-14.64%) and divorced ones (14.89%, 95%CI: 12.37%-17.50%). The prevalence of cognitive disorder among rural population (12.16%, 95%CI: 9.51%-14.82%) was higher than it among urban population (5.93%, 95%CI: 4.78%-7.07%). The prevalence in central area (13.57%, 95%CI: 8.55%-18.58%) was higher than that in east (7.96%, 95%CI: 6.17%-9.74%) and west region (9.50%, 95%CI: 7.62%-11.38%) of China. The difference was statistically significant (χ(2) = 54.55, 29.76, 8.81 respectively, P < 0.05).</p><p><b>CONCLUSION</b>The prevalence of cognitive disorder among the elderly people over 60 years old was age-related and varied by different gender, marriage status, educational status and the regional distribution.</p>

Prevalence and characteristic of overweight and obesity among adults in China, 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the prevalence and characteristics of overweight and obesity among Chinese adults aged 18 and above, in year 2010.</p><p><b>METHODS</b>A total of 98 271 adults aged 18 and above, who were sampled from 162 surveillance points of 31 provinces of China mainland, were enrolled in the study. Weight and height of each subject were measured, and then body mass index (BMI) was calculated. Overweight was defined as 24 kg/m² ≤ BMI < 28 kg/m², while obesity was defined as BMI ≥ 28 kg/m². After complex weighting, the prevalence of overweight and obesity among total population and specified rates among different populations by gender and districts and age were calculated.</p><p><b>RESULTS</b>Prevalence rate of overweight among Chinese adults was 30.6%, separately at 31.5% and 29.7% among males and females (χ² = 16.05, P < 0.01); 27.1%, 37.2% and 32.3% in groups of population aged 18 - 44, 45 - 59 and over 60 year-old, respectively (χ² = 482.00, P < 0.01); separately at 33.9% and 29.1% in urban and rural areas (χ² = 21.14, P < 0.01); 32.0%, 31.1% and 28.0% in eastern, central and western regions, respectively (χ² = 8.72, P < 0.05). Prevalence rate of obesity among Chinese adults was 12.0%, separately at 11.9% and 12.1% among males and females (χ² = 0.33, P > 0.05); and 10.6%, 14.7% and 12.6% in groups of populations aged 18 - 44, 45 - 59 and over 60 year-old, respectively (χ² = 111.25, P < 0.01); separately at 14.2% and 11.0% in urban and rural areas (χ² = 12.11, P < 0.01); and 13.5%, 11.9% and 9.9% in eastern, central and western regions, respectively (χ² = 10.05, P < 0.01). The total prevalence rate of overweight and obesity among Chinese adults was 42.6%. It appeared that the total prevalence rate of overweight and obesity among urban populations (48.1%) were higher than rural populations (40.1%) (χ² = 20.37, P < 0.01); while the total rate showed a gradual decreasing trend from eastern (45.5%) to central (43.0%) and western (37.9%) regions (χ ²= 10.46, P < 0.01).</p><p><b>CONCLUSION</b>The prevalence of overweight and obesity were comparatively high among Chinese adults aged 18 and above in year 2010, and significant differences could be found among gender, age, urban or rural areas and eastern, central or western districts.</p>

Disease burden of chronic obstructive pulmonary diseases in west rural areas of China, 2004 - 2005 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the death burden of chronic obstructive pulmonary diseases (COPD) in west rural areas of China in 2004 - 2005.</p><p><b>METHODS</b>The data from 2004 - 2005 the Third National Mortality Retrospective Sampling Survey were used in the study. A total of 28 621 276 person years were investigated in west rural areas, which covered 12 provinces, and consisted of 42 surveillance districts. Based on the data of death cause and population, mortality of COPD, years of potential life lost(YPLL) rate, working YPLL (WYPLL) rate, YPLL rate due to COPD/YPLL rate due to all deaths in west rural areas were calculated and compared with other rural areas. Standardized death rate, standardized YPLL (SYPLL) rate, standardized working YPLL (SWYPLL) rate were calculated from census data in 2000 as standard population and 2004 - 2005 national life expectancy as standard life expectancy.</p><p><b>RESULTS</b>The elder has the higher crude death rate and YPLL rate of COPD in survey districts of west rural areas. And the crude death rate of COPD and YPLL rate were different in different genders. The YPLL rate was 15.47‰ in male and 15.73‰ in female. The crude death rate, YPLL rate, WYPLL rate, the ratio of YPLL rate due to COPD/YPLL rate due to all deaths in survey districts of west rural areas were: 109.53/100 000, 15.76‰, 2.82‰, 11.23%, which were high. While crude death rate, YPLL rate, WYPLL rate, the ratio of YPLL rate due to COPD/YPLL rate due to all deaths in the poorest survey districts of west rural areas were: 122.04/100 000, 27.47‰, 4.26‰, 13.44%, which were higher than other stratifications of west rural areas.</p><p><b>CONCLUSION</b>The death burden of COPD in west rural areas in 2004 - 2005 was the heaviest one in China which experienced the feature that the poorer the rural regions, the heavier the death burden.</p>

Mortality and death cause proportion of respiratory disease in China, 2004-2005 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the mortality and death cause proportion of respiratory disease in China, 2004-2005.</p><p><b>METHODS</b>Data of representative district (160 spots of national disease surveillance system) from 2004-2005 the 3rd national retrospective sampling survey of death cause were used for presenting mortality experience of respiratory diseases during 2004-2005 in urban and rural districts, different regions and in population of different genders and age groups. The total person years were 142 660 482 and standardized death rates were calculated from census data in 2000 and each five-year was counted as an age group.</p><p><b>RESULTS</b>The crude death rate of respiratory disease in survey districts (2004-2005) was 100.12/100 000 (144 106 cases), the standardized death rate was 87.56/100 000. The crude death rate and standardized death rate in male were 106.49/100 000 (77 709 cases) and 104.52/100 000. Those in female were 95.27/100 000 (66 397 cases) and 72.96/100 000, respectively. The crude death rate and standardized death rate in urban area were 86.00/100 000 (41 193 cases) and 68.60/100 000. Those in rural area were 108.60/100 000 (102 913 cases) and 97.74/100 000, respectively. The crude death rate and standardized death rate in eastern region were 95.69/100 000 (50 293 cases) and 69.33/100 000, central region 88.61/100 000 (44 113 cases) and 87.38/100 000, western region 123.26/100 000 (49 700 cases) and 116.37/100 000, respectively. The crude death rate and standardized death rate of respiratory infectious were 12.40/100 000(17 688 cases) and 10.91/100 000, chronic obstructive pulmonary disease (COPD) 82.32/100 000 (117 440 cases) and 71.18/100 000, asthma 2.45/100 000 (3500 cases) and 2.14/100 000, bronchiectasis 0.25/100 000 (362 cases) and 0.22/100 000, pneumoconiosis 0.62/100 000 (878 cases) and 0.56/100 000. Death from COPD accounted for 81.49% of total respiratory death cases, infectious respiratory 12.27%, asthma 2.43%.</p><p><b>CONCLUSION</b>The mortality of respiratory disease was greater in rural area than that in urban area in China during 2004-2005; greater in western region than that in eastern and central regions; greater in male than that in female. The mortality of COPD and its contribution to the total mortality of respiratory diseases were high.</p>

Epidemiologic characteristics of cerebrovascular disease mortality in China, 2004-2005 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To describe the epidemiologic characteristics of cerebrovascular disease (CVD) mortality in China from 2004 to 2005.</p><p><b>METHODS</b>The data came from 2004-2005, the third national mortality retrospective sampling survey which collected the death cause information and covered 31 province-level regions and 160 surveillance spots in the interior of China. Total 142 660 482 person years were investigated. Based on the data, the crude death rates of ages, genders and diseases were calculated. Years of potential life lost (YPLL) were also calculated. Standardized death rates were calculated from census data in 2000 and each five-year was counted as an age group.</p><p><b>RESULTS</b>The total number of residents died of CVD between 2004 and 2005 was 194 932 (male 108 414, female 86 518, urban 63 397, rural 131 535) in survey districts. The crude death rates of CVD were 136.6 per 100 000 and the standardized death rate was 120.1 per 100 000. The crude death rates of CVD were 148.6 per 100 000 in male and 124.1 per 100 000 in female; the standardized death rates were 144.2 and 98.2, respectively. The crude death rates of CVD were 132.4 per 100 000 in urban area and 138.8 per 100 000 in rural area; the standardized death rates were 107.3 and 127.6 per 100 000 population, respectively. With age increasing, the crude death rates of CVD showed a fast growth trend. The crude death rates of group aged 35 - 39, 55 - 59, 85 and above were 10.6 (1352/12 712 639), 177.6 (10 599/5 967 274) and 4051.4 (25 430/627 688) per 100 000 respectively. Intracerebral hemorrhage accounting for 50.4% (98 324 cases) of CVD deaths, followed by cerebral infarction, accounting for 24.8% (48 305 cases). The total cases of stroke, hemorrhagic stroke, ischemic stroke and not-specified stroke were 167 147, 105 766, 48 305 and 13 076, respectively, and the crude death rates were 117.2, 74.7, 33.9 and 11.3 per 100 000, respectively. The YPLL of Chinese people was 535.5 person years per 100 000.</p><p><b>CONCLUSION</b>The mortality of CVD in male was higher than that in female; the mortality of CVD in urban area was higher than that in rural area. As the age increasing, the mortality of CVD appeared a rapid increment. Intracerebral hemorrhage was the main cause of CVD death.</p>

The mortality trends of infectious diseases, maternal and perinatal diseases, and nutritional deficiencies in China, 1973-2005 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the mortality and the constitution of total deaths of infectious disease, maternal and perinatal diseases, nutritional deficiencies and their trends in China, 1973-2005.</p><p><b>METHODS</b>The following data collected from three national retrospective sampling surveys of death causes were used: 1973-1975 nation-wide cancer mortality survey for person years of approximately 2 513 949 310; 1990-1992 nation-wide cancer mortality survey for person years of approximately 335 213 493; 2004 - 2005 the 3rd national retrospective sampling survey of death cause for person years of approximately 142 660 482 by three age groups (0-, 15- and 60-). Based on the data, the crude death rates of ages, genders and diseases were calculated. The standardized death rates were calculated using the population census data of 2000.</p><p><b>RESULTS</b>The total number of deaths caused by infectious diseases, maternal and perinatal diseases, and nutritional deficiencies were 4 913 521, 284 811 and 47 161 in 1973-1975, 1990-1992 and 2004-2005, respectively; the crude death rates were 195.45, 84.96, 33.06 per 100 000, and the standardized death rates were 158.71, 70.76, 27.98 per 100 000. Total number of deaths caused by the above diseases in urban and rural areas were 11 752 and 35 409 during 2004 - 2005, respectively; the crude death rates were 24.69 and 37.35 per 100 000, and the standardized death rates were 19.62 and 32.12 per 100 000. There were 26 176 deaths due to the above diseases in male and 20 985 in female; the crude death rates were 35.87 and 30.11 per 100 000; the standardized death rates were 35.23 and 26.65 per 100 000. The number of deaths reported in different regions were 13 286, 13 922 and 19 953 in eastern, central and western areas respectively; the crude death rates were 25.28, 27.97 and 49.48 deaths per 100 000; the standardized death rates were 21.33, 28.10 and 45.98 per 100 000. The top three causes of death were pneumonia, tuberculosis and virus hepatitis, and the case numbers were 14 265, 8537 and 5771, respectively. The death rates were 10.00, 5.98 and 4.05 per 100 000, the standardized death rates were 8.88, 5.46 and 3.74 per 100 000. The percentage of total deaths (868 484 cases) of infectious diseases, maternal and perinatal diseases, and nutritional deficiencies was 5.43%, which was decreased 80.52% from 1973 - 1975 (27.87%, 4 913 521/17 629 350).</p><p><b>CONCLUSIONS</b>The mortality of infectious diseases, maternal and perinatal diseases, and nutritional deficiencies were generally consistent with long-term decreasing trends observed, the mortality in urban area was greater than that in rural area, the rate in male was greater than that in female, the rate in western region was greater than that in central and eastern regions.</p>

Analysis of negative life events among 304 elderly suicide victims / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identify the most common life events that occurred prior to suicide in elderly individuals and the relationship of these life events to depressive symptoms.</p><p><b>METHODS</b>A detailed study considering life events in the year prior to death, the presence of mental illness at the time of death and the level of depressive symptoms in the 2 weeks prior to death was undertaken with the family members and other associates of 304 persons at 55 years of age and older who died of suicide.</p><p><b>RESULTS</b>The three most common negative life events were acute or chronic physical illness or injury (59.2%), major changes in diet, sleeping or other daily routines (37.8%) and financial difficulties (34.5%). The severity of depressive symptoms was significantly greater among persons who had experienced these life events both for persons with or without definite mental illness.</p><p><b>CONCLUSION</b>Most elderly persons who died of suicide events had experienced multiple negative life events in the year prior to death and these life events were closely related to the severity of depressive symptoms at the time of death.</p>

The trend and geographic distribution of suicide in Chinese population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the specific patterns of suicide in Chinese population and its trend.</p><p><b>METHODS</b>The mortality level and trend of suicide in Chinese population by sex, age and areas were reviewed and the geographic distribution of suicide mortality was described using National Disease Surveillance Data in 1991 - 2000.</p><p><b>RESULTS</b>During 1991 - 2000, the mortality rate of suicide was stable. Suicide was still one of the main health problems in Chinese population, especially in rural areas. The pattern of suicide in rural areas remained the same as reported before. The death rate of suicide attempts in female was higher than in male. There was a peak of death rate among rural people aged 15 - 34. However the death rate among rural women aged 15 - 34 was falling, which did not significantly affect the current suicide pattern.</p><p><b>CONCLUSIONS</b>There was high death rate of suicide in eastern and central rural areas, especially in boundaries among provinces, which could have been related to traditional culture, economic situation etc. Using pesticide as a tool of suicide was also an important factor with high death rate of suicide. These findings suggested that the specific pattern would last for another 20 years along with the social development and reform.</p>

Study on the trend and disease burden of injury deaths in Chinese population, 1991 - 2000 / 中华流行病学杂志

<p><b>OBJECTIVE</b>The mortality and trend of injury in 1991 - 2000, the distribution of causes of injuries by areas as well as disease burden in Chinese population were discussed.</p><p><b>METHODS</b>Data on mortality level and causes of injuries provided by National Disease Surveillance Program in 1991 - 2000, adjusted by under-reporting rate together with years of potential life lost (YPLL) and WPYLL of injuries and proportion of YPLL and WPYLL of total death, were calculated.</p><p><b>RESULTS</b>The mortality of injury was kept at a stable level from 1991 to 2000. The adjusted average death rates were 66.56/100,000 with 81.41/100,000 in males, 51.17/100,000 in females, and 38.68/100,000, 74.63/100,000 in urban and rural populations respectively. Death rates of injury in the east, central and west rural areas were 1:1.14:1.21 respectively. Injury was the main cause of death among children and youths. Traffic accident, suicide, drowning, poisoning and fall were main causes of injury accounting for 70 percent of all the injury mortality. Since 1990's, the death rate of traffic accident had been obviously increasing, YPLL and WPYLL in injury 2132 years/10,000 and 1587 years/10,000, respectively. The YPLL and WPYLL were 24.56% and 26.51% of total deaths.</p><p><b>CONCLUSION</b>The disease burden of injury was heavy and the death of injury caused more social and economic losses owing to premature death. The increasing death rate of traffic accident called for more attention. Different effective control strategies should be formulated based on different death causes of injury and different target populations.</p>

Evaluation on the accuracy of reported suicides in the Chinese population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of reports of suicide in the national death registry systems and to estimate a more accurate suicide rate.</p><p><b>METHODS</b>Twenty-three sites from the Disease Surveillance Points Network-one of the national death registry systems-were selected and 1 932 of the deaths that occurred at these sites from August 1995 through August 2000 in which the official cause was classified as "accidental" or "mental illness" were selected for detailed household surveys focusing on reassessing the cause of death. Valid interviews were completed in 1 653 of these cases. The original cause of death recorded on the death certificate was compared with the finding of the detailed household survey and the result was used to adjust the suicide rate.</p><p><b>RESULTS</b>After detailed investigation, 16 of the 857 (1.87%) deaths reported on the death certificate as suicide were considered accidental deaths, 39 of the 721 (5.41%) accidental deaths were considered suicide, 17 of the 35 (48.57%) cases reported as undetermined accidents were considered suicide, and 6 of the 40 (15.00%) cases in which mental illness was the recorded cause of death were considered suicide. After adjustments for errors in the reported cause of death and for missing deaths, the reported crude suicide rate of 13.65/100 000 in China was adjusted to 22.99/100 000 (95% CI: 21.78/100 000 - 24.25/100 000).</p><p><b>CONCLUSION</b>After adjustments the actual suicide rate for China was higher than the reported rate indicating that suicide was an increasingly important public health problem for China.</p>