[Disease burden of acute viral hepatitis in Guangdong Province, 1990-2019].

Objective: To examine the burden and trends of acute viral hepatitis in Guangdong Province from 1990 to 2019, and provide reference evidences for hepatitis prevention and control in the province. Methods: Data on acute viral hepatitis (hepatitis A, B, C, and E) in Guangdong from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 database. The incidence, prevalence, mortality, and disability-adjusted life years (DALY) data were analyzed by age and gender, and the estimated annual percentage change (EAPC) was calculated to describe the changing trends in disease burden. Results: From 1999 to 2019, the standardized incidence, prevalence, mortality, and DALY of acute viral hepatitis in Guangdong were higher than the national averages. In 2019, 51.43% (2 245 087/4 365 221) of acute viral hepatitis cases in Guangdong Province were mainly attributed to hepatitis B, and 77.18% (106/138) of deaths were due to acute hepatitis B. In different age groups, except for acute hepatitis B, which was more common in adults, the incidence rates of other types of viral hepatitis such as hepatitis A, B, and E showed an overall decreasing trend with age. The mortality rates of different types of acute viral hepatitis, except for the <5 age group, increased with age. The overall incidence and mortality rates of acute viral hepatitis were higher in men than in women. Conclusions: The overall burden of acute viral hepatitis in Guangdong declined in 2019, but remained higher than the national level. Further efforts are needed to strengthen hepatitis prevention and screening in different population in Guangdong Province, especially in children and the elderly.

[Mediating effect of hypertension on risk of stroke associated with hyperuricemia].

Objective: To investigate the association between hyperuricemia and the risk for stroke occurrence, as well as the mediating effect of hypertension on this association. Methods: In this study, the China Chronic Diseases and Nutrition Surveillance system in 2015 was used as baseline data. We identified hospital admissions for stroke using the electronic homepage of inpatient medical records from 2013-2020, and death data were obtained from the 2015-2020 National Mortality Surveillance System. A retrospective cohort was established after matching and linking the database. The Cox proportional hazard regression model was used to analyze the relationship between hyperuricemia and the risk of stroke and its subtypes. Restricted cubic spline analysis was conducted to examine the dose-response relationship between serum uric acid levels and the risk for stroke. Mediation analysis was performed to investigate the mediating effect of hypertension on the association between hyperuricemia and the risk for stroke and its subtypes. Subgroup analyses were conducted based on gender and age groups. Results: A total of 124 352 study subjects were included, with an accumulative follow-up time of 612 911.36 person-years. During the follow-up period, 4 638 cases of stroke were found, including 3 919 cases of ischemic stroke and 689 cases of hemorrhagic stroke. The incidence density of stroke was 756.72 per 100 000 person-years, 641.37 per 100 000 person-years for ischemic stroke, and 114.60 per 100 000 person-years for hemorrhagic stroke. Multivariable Cox proportional hazards regression models showed that after adjusting for covariates, compared to those without hyperuricemia, individuals with hyperuricemia had a 16% higher risk for stroke [hazard ratio (HR)=1.16, 95%CI: 1.06-1.27], a 12% higher risk of ischemic stroke (HR=1.12, 95%CI: 1.01-1.24), and a 39% higher risk of hemorrhagic stroke (HR=1.39, 95%CI: 1.11-1.75). Mediation analysis showed that hypertension partially mediated the associations between hyperuricemia and the risk for stroke, ischemic stroke, and hemorrhagic stroke, with mediation proportions of 36.07%, 39.98%, and 25.34%, respectively. The mediating effect is pronounced in the male population and individuals below 65. Conclusion: Hyperuricemia is a risk factor for stroke, and hypertension partially mediates the effect of hyperuricemia on stroke.

[Study on behavioral risk factors and lagging effect analysis with liver cancer mortality in rural critical areas of 4 provinces of China from 2009 to 2019].

Objective: To analyze the trend of liver cancer mortality in rural key areas of Jiangsu Province, Anhui Province, Shandong Province, and Henan Province (4 provinces) from 2009 to 2019 and to explore the influence of behavioral risk factors on liver cancer mortality and its lagging effect, and provide a reference for the prevention and treatment of liver cancer in China. Methods: Based on the 2009-2019 National Cause of Death Surveillance Database of the Chinese Center for Disease Control and Prevention, and the survey data of tumor and risk factor behavior of residents in key areas of 4 provinces, Joinpoint 4.2 software was used to calculate the average annual percentage change (AAPC) for assessing the temporal trend of standardized mortality of liver cancer; Chi-square test and trend Chi-square test were used to analyze the regional distribution difference and temporal change trend of behavioral habit factors. Stata 16 was used to establish a panel model to analyze the correlation and lagging effect of behavioral risk factors with liver cancer. Results: The standardized mortality rate of liver cancer in Jinhu County, Sheyang County, Lingbi County, Shou County, Mengcheng County, Wenshang County, Juye County, Luoshan County, Shenqiu County, and Xiping County showed a downward trend (AAPC<0, P<0.05) from 2009 to 2019. The consumption frequency of pickles/salted fish, red meat, and aquatic products showed a downward trend. The consumption frequency of healthy foods such as fresh vegetables, fresh fruits, and dairy products in all counties and districts showed an upward trend, and the consumption frequency of fried foods, kimchi, smoked foods, moldy foods, coffee, and soy products remained at a low level (P<0.05); but the consumption frequency of soy products and dairy products was still <20.00%. Fried food, pickles/salted fish, current smoking rate, alcohol consumption rate, and unvaccinated hepatitis B vaccine rate were positively correlated with liver cancer death, and there was a lag effect, and the lag period was 4, 1, 6, 5, 4 years respectively. Conclusions: From 2009 to 2019, the mortality rate of liver cancer in rural key areas of 4 provinces shows a downward trend. There is a correlation and lagging effect between behavioral risk factors such as fried food, smoking, and alcohol consumption and liver cancer death.

[Analysis on liver cancer mortality and cause eliminated life expectancy in key areas of 4 provinces, China, 2008-2018].

Objective: To explore the changes of liver cancer mortality and the effect of liver cancer on life expectancy in key areas of four provinces in China from 2008 to 2018 and provide the basis for the evaluation of comprehensive prevention and control of cancer and promotion of the rational allocation of health resources. Methods: Based on the national cause-of-death surveillance in key areas of the 4 provinces from 2008 to 2018, we analyzed the mortality of liver cancer, cause eliminated life expectancy (CELE) and potential gains in life expectancy (PGLEs). Software Joinpoint 4.9.0.0 was used to calculate the average annual percentage change (AAPC). Arriaga's decomposition method was used to estimate the contribution of the changes of liver cancer mortality in each age group to life expectancy. Results: The standardized mortality of liver cancer in key areas of the 4 provinces showed a downward trend from 2008 to 2018 (AAPC=-4.37%, P<0.001). The changes of liver cancer mortality had a positive effect on the increase of life expectancy, with a contribution value of 0.240 years and a contribution degree of 5.62%. The positive effect was greatest in age group 45-49 years (0.041 years, 0.96%), and the negative effect was greatest in age group 50-54 years (-0.015 years, -0.35%). Compared with 2008, the life expectancy increased by 4.27 years (AAPC=0.59%, P<0.001), the liver cancer CELE increased by 4.20 years (AAPC=0.58%, P<0.001), the PGLEs decreased by 0.07 years (AAPC=-0.62%,P<0.001), and life loss rate decreased by 0.13% (AAPC=-1.18%, P=0.001). The liver cancer PGLEs increased in Yongqiao district, Anhui province (0.09 years), and decreased in other districts (counties), with the largest decline was in Fugou county, Henan province (-0.21 years). Conclusions: From 2008 to 2018, the standardized mortality rate of liver cancer in key areas of the 4 provinces decreased gradually, contributing to the growth of life expectancy. The life loss caused by liver cancer decreased gradually, but the PGLEs varied with districts (counties).

[Mortality trend of chronic respiratory diseases in China, 1990-2019].

Objective: To analyze mortality and its trend of chronic respiratory diseases (CRD) in China from 1990 to 2019. Methods: Based on the provincial results of China from the 2019 Global Burden of Disease (GBD) study, the average annual percent change (AAPC) of standardized mortality rates of different CRDs were analyzed by using Joinpoint 4.8.0.1, and the age-standardized mortality rate of CRD was calculated by using the GBD 2019 world standard population. Based on the comparative risk assessment theory of GBD, the attributable deaths due to 12 CRD risk factors were estimated, including smoking, indoor air pollution, occupational gas exposure, particulates and smog exposure, environmental particulate pollution, low temperature, passive smoking, ozone pollution, occupational exposure to silica, occupational asthma, high body mass index, high temperature and occupational exposure to asbestos. Results: From 1990 to 2019, the number of deaths and standardized mortality of chronic obstructive pulmonary disease (COPD) showed a downward trend (P<0.001). The number of COPD deaths decreased from 1 244 000 (912 000 - 1 395 000) in 1990 to 1 037 000 (889 000 - 1 266 000) in 2019. AAPC=-0.9% (95%CI: -1.5% - -0.3%), P<0.001; The standardized mortality rate decreased from 217.9/100 000 (163.3/100 000 - 242.0/100 000) in 1990 to 65.2/100 000 (55.5/100 000 - 80.1/100 000) in 2019. AAPC= -4.2% (95%CI:-5.2% - -3.2%), P<0.001. The number of deaths from asthma decreased from 40 000 (30 000 - 58 000) in 1990 to 25 000 (20 000 - 31 000) in 2019. AAPC=-2.0% (95%CI: -2.6% - -1.4%), P<0.001; The standardized mortality rate of asthma decreased from 6.4/100 000 (4.7/100 000 - 9.5/100 000) in 1990 to 1.5/100 000 (1.2/100 000 - 1.9/100 000) in 2019. AAPC=-5.1% (95%CI: -5.8% - -4.4%), P<0.001. The number of pneumoconiosis deaths decreased from 11 000 (8 000 - 14 000) in 1990 to 10 000 (8 000 - 14 000) in 2019, AAPC=-0.2%(95%CI:-0.4% - 0.1%), P=0.200; The standardized mortality rate of pneumoconiosis decreased from 1.4/100 000 (1.0/100 000 - 1.7/100 000) in 1990 to 0.5/100 000 (0.4/100 000 - 0.7/100 000) in 2019. AAPC=-3.1% (95%CI: -3.4% - -2.8%), P<0.001. The number of deaths from pulmonary interstitial diseases and pulmonary sarcoidosis increased from 3 000 (3 000 - 6 000) in 1990 to 8 000 (6 000 - 10 000) in 2019, AAPC=3.5% (95%CI: 2.7% - 4.2%), P<0.001; The corresponding standardized mortality rate changed little from 1990 to 2019, and AAPC was not statistically significant.The age-standardized mortality rates of different CRDs were higher in men than those in women. In 1990 and 2019, the mortality rates of COPD, asthma, pneumoconiosis and interstitial pulmonary disease and pulmonary sarcoidosis increased with age. In 2019, the population attributable fractions (PAFs) for smoking, environmental particulate pollution, occupational gas exposure, particulate and smog exposure, low temperature exposure and passive smoking were 71.1% (68.0% - 74.3%), 24.7% (20.1% - 30.0%), 19.3% (13.0% - 25.4%), 15.7% (13.6% - 18.3%) and 8.8% (4.5% - 13.1%) respectively in men, and the PAFs for environmental particulate pollution, smoking, low temperature exposure, occupational gas exposure, particulate and smog exposure, and passive smoking were 24.1% (19.6% - 29.3%), 21.9% (18.7% - 25.2%), 16.4% (14.0% - 19.2%), 15.6% (10.2% - 21.1%) and 14.7% (7.9% - 21.3%) respectively in women. Conclusions: During 1990-2019, the overall death level of CRD decreased significantly in China, but it is still at high level in the world. Active prevention and control measures should be taken to reduce the death level caused by CRD.

[Disease burden of breast cancer in women in China, 1990-2017].

Objective: To analyze the trend of the incidence, mortality and disease burden of breast cancer in women in China during 1990-2017. Methods: Based on the estimation of data in China from the Global Burden of Disease 2017 (GBD2017), the incidence,mortality, disability- adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) on breast cancer for women in China during 1990-2017 were standardized by the world standard population used for GBD2017. The GBD study applied the attributable burden formula to estimate the attributable deaths by five risk factors of breast cancer, including alcohol use, high body mass index (BMI), high fasting plasma glucose, low physical activity and tobacco smoking. The incidence, mortality, attributable deaths and the disease burden due to breast cancer in women in China were analyzed. Results: In 2017, a total of 357.6 thousand female breast cancer cases, including 84.8 thousand deaths, were reported in China, with the age-standardized incidence rate of 35.62/100 000, which increased by 286.18%, 114.14% and 88.77% respectively compared with 1990. The age-standardized mortality rate decreased from 8.57/100 000 in 1990 to 7.84 /100 000 in 2007, then increased to 8.71 /100 000 in 2015, and then decreased to 8.47/100 000 in 2017. The mortality of breast cancer increased with age in 1990 and 2017. From 1990 to 2017, the trend of standardized DALY rate and standardized YLL rate were the same as that of standardized mortality, while the standardized YLD rate and the proportion of YLD in DALY increased year by year. In 2017, the standardized DALY rate, standardized YLL rate and standardized YLD rate of breast cancer were 253.00/100 000, 228.96/100 000, and 24.05/100 000, respectively. Compared with 1990, the change rates were -6.88% and -11.73% and 95.85% respectively. The proportion of breast cancer deaths attributable to high BMI increased significantly by 165.76%, from 5.49% in 1990 to 14.59% in 2017. The proportion of breast cancer deaths attributable to alcohol use and high fasting blood glucose increased; and the proportion of breast cancer deaths attributed to low physical activity and smoking remained stable. In 2017, the three provinces with the highest age-standardized mortality rate of female breast cancer were Hongkong (9.93/100 000), Guangxi (9.52/100 000) and Liaoning (9.49/100 000). Compared with 1990, the age-standardized mortality of 19 provinces decreased, and Beijing (-27.17%), Macao (-26.06%) and Jilin (-23.89%) had the fastest decrease. The two provinces with the highest growth rates were Hebei (28.85%) and Henan (24.34%). Conclusions: The disease burden of female breast cancer in China increased during 1990-2017. Therefore it is necessary to strengthen the prevention and treatment of breast cancer.

[Analysis on all-cause mortality rate and life expectancy in China, 2005-2018].

Objective: To understand the geographical variations and temporal trends of all-cause mortality rate and life expectancy in China at national and subnational levels during 2005-2018. Methods: Using data from National Cause-of-death Reporting System, China National Maternal and Child Health Surveillance System, Under-reporting Surveys, and related social determinants covariates, we estimated all-cause mortality rate and life expectancy at national and subnational levels in China during 2005-2018. We depicted the geographical variations and temporal trends between provinces on mortality rate and life expectancy. We then decomposed changes in national and subnational deaths into three explanatory components: change due to age-specific mortality rate, change due to the population structure by age, and change due to growth of the total population. Results: In 2018, it was estimated that there were 10 482 297 total deaths (95%CI: 9 723 233-11 466 875 deaths) in China, with 6 113 926 men (95%CI: 5 773 158-6 572 407 men) and 4 368 241 women (95%CI: 3 950 075-4 894 468 women). The all-cause mortality rate was 755.54 per 100 000 (95%CI: 701.49 per 100 000-825.78 per 100 000), with 861.78 per 100 000 (95%CI: 813.75 per 100 000-926.40 per 100 000) in men and 642.73 per 100 000 (95%CI: 581.20 per 100 000-720.15 per 100 000) in women, while age-standardized all-cause mortality rate was 652.27 per 100 000 (95%CI: 599.22 per 100 000-721.71 per 100 000), with 806.38 per 100 000 (95%CI: 755.10 per 100 000-874.31 per 100 000) in men and 503.37 per 100 000 (95%CI: 450.50 per 100 000-572.01 per 100 000) in women. In 2018, it was estimated that the life expectancy in the whole country was 77.15 years old (95%CI: 75.92-78.11 years old), with 74.81 (95%CI: 73.57-75.76) in men and 79.87 (95%CI: 78.61-80.91) in women. Developed areas as Shanghai, Beijing, Jiangsu, and Zhejiang owned comparatively higher life expectancy, while undeveloped areas like Tibet, Guizhou, Xinjiang, and Qinghai showed lower levels. During 2005-2018, there was a 29.87% increase in total deaths at the national level, with 27.74% in men and 31.29% in women. Changes due to age-specific mortality rate, the population structure by age, and the growth of the total population constituted -35.74%, 7.34%, and 58.28% of the total increase, respectively. Conclusions: From 2005 to 2018, the all-cause mortality rate increased while the age-standardized mortality rate decreased substantially among Chinese residents. Change due to population structure by age was the dominant driver. An upward trend of life expectancy was observed in all provinces, with marked differences between the provinces.

[Analysis on factors associated with the place of death among individuals with cardiovascular diseases in China, 2018].

Objective: To understand the distribution patterns of the place of death (PoD) among individuals with cardiovascular disease (CVD) in the provinces of China in 2018. Relationships between CVD deaths in healthcare/medical institutions and individual demographics, social-economic status (SES), the underlying cause of death, and local cultural factors were also explored. Methods: Using data from the National Cause-of-death Reporting System, we examined potential, influential factors of CVD deaths in healthcare/medical institutions through multilevel logistic regression. Results: In 2018, there were 853 832 CVD deaths in disease surveillance points in the country, with 661 625 (77.49%) home deaths and 156 441 (18.32%) occurring in healthcare and medical institutions. Factors including sex, age, nationality, marital status, education level, occupation, the underlying cause of death, criterion for diagnosis, and urban/rural residency, were significantly influential on CVD deaths in healthcare/medical institutions. Meanwhile, spatial variations were shown at factors the subnational level, with 45.39% related to factors at the individual level. Conclusion: Home was the dominant place for CVD deaths in the country, with substantial spatial variations in PoD between provinces. The probability of dying in healthcare/medical settings was comparatively higher among CVD patients with superior socioeconomic status and who lived in urban areas. Adequate information should be collected and included in further studies on exploring influential factors of PoD. Since both social factors, individual preferences, and acute and chronic CVD deaths are critical, it is necessary to enhance treatment capacity. A booming approach incorporating home/hospice care with on-site medical services might also improve the quality of end-of-life care among CVD patients in China.

[Influences of using different spatial weight matrices in analyzing spatial autocorrelation of cardiovascular diseases mortality in China].

Objective: To explore the potential influences and applicability of different spatial weight matrices used in analyzing spatial autocorrelation of cardiovascular disease (CVD) mortality in China. Methods: Using data from the National Cause-of-death Reporting System, we used adjacency-based Rook and Queen contiguity and distance-based K nearest neighbors/distance threshold. We then conducted global and local spatial autocorrelation analysis of CVD mortality at the county level in China, 2018. Results: All four categories and 26 types of spatial weight matrices had detected significant global and local spatial autocorrelation of CVD mortality in China. Global Moran's I statistics reached its peak when using first-order Rook (0.406), first-order Queen (0.406), K nearest neighbors including five spatial units (0.409), and distance threshold with 100 kilometers (0.358). Meanwhile, apparent local spatial autocorrelation was found in CVD mortality. Substantial disparities were observed when detecting "High-High clusters", "Low-Low clusters", "High-Low clusters" and "Low-High clusters" of CVD mortality spatial distribution by using different weight matrices. Conclusions: Using different spatial weight matrices in analyzing the spatial autocorrelation of CVD mortality, we could understand the spatial distribution characteristics of CVD mortality in-depth at the county level in China. In this way, adequate supports could also be provided on CVD premature death control and rational medical resource allocation regionally.

S doped NiCo2O4 nanosheet arrays by Ar plasma: An efficient and bifunctional electrode for overall water splitting.

Transition metal oxides show great potential as electrocatalysts, owing to the low cost and rich chemical states. However, the limited surface areas, low intrinsic activity and poor hydrogen evolution reaction (HER) activity greatly restrict the application for overall water splitting. Herein, we have constructed S doped NiCo2O4 nanosheet arrays by Ar plasma (Ar-NiCo2O4|S) to enhance active sites and boost catalytic kinetics. Consequently, the Ar-NiCo2O4|S shows the improved performances for HER and oxygen evolution reaction (OER). Further, as bifunctional electrocatalysts, Ar-NiCo2O4|S exhibit a voltage of 1.63 V at 10 mA cm-2, as well as good stability.

[The disease burden of pancreatic cancer in China in 1990 and 2017].

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.

Involvement of LeMRP, an ATP-binding cassette transporter, in shikonin transport and biosynthesis in Lithospermum erythrorhizon.

Shikonin and its derivatives are important medicinal secondary metabolites accumulating in roots of Lithospermum erythrorhizon. Although some membrane proteins have been identified as transporters of secondary metabolites, the mechanisms underlying shikonin transport and accumulation in L. erythrorhizon cells still remain largely unknown. In this study, we isolated a cDNA encoding LeMRP, an ATP-binding cassette transporter from L. erythrorhizon, and further investigated its functions in the transport and biosynthesis of shikonin using the yeast transformation and transgenic hairy root methods, respectively. Real-time PCR was applied for expression analyses of LeMRP and shikonin biosynthetic enzyme genes. Functional analysis of LeMRP using the heterologous yeast cell expression system showed that LeMRP could be involved in shikonin transport. Transgenic hairy roots of L. erythrorhizon demonstrated that LeMRP overexpressing hairy roots produced more shikonin than the empty vector (EV) control. Real-time PCR results revealed that the enhanced shikonin biosynthesis in the overexpression lines was mainly caused by highly up-regulated expression of genes coding key enzymes (LePAL, HMGR, Le4CL and LePGT) involved in shikonin biosynthesis. Conversely, LeMRP RNAi decreased the accumulation of shikonin and effectively down-regulated expression level of the above genes. Typical inhibitors of ABC proteins, such as azide and buthionine sulphoximine, dramatically inhibited accumulation of shikonin in hairy roots. Our findings provide evidence for the important direct or indirect role of LeMRP in transmembrane transport and biosynthesis of shikonin.

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030].

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

[Death and impact of life expectancy attributable to smoking in China, 2013].

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].

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-reduction are urgently needed in China and related cost-effectiveness is highly expected.

[Effects of insufficient physical activity on motality and life expectancy in adult aged 25 and above among Chinese population].

Objective: To analyze the attribution of mortality and impact on life expectancy caused by insufficient physical activity in different gender and areas in adults aged ≥25 years among Chinese people. Methods: Data from the programs related to Chinese death surveillence, risk factors of chronic survey, health outcomes of physical activity as well as relative risk (RR) on Global Burden of Disease (GBD) study were used. Population attributable fraction (PAF) of different health outcomes attributable to deaths that caused physical activity and the influence of life expectancy in adults aged ≥25 years in Chinese people were calculated. Results: The overall PAF for all cause of death due to physical activity in adults aged ≥25 years was 4.24%, with 4.86% in females and 3.82% in males. The health outcomes of inadequate physical activity would include breast cancer, colorectal cancer, ischemic heart disease, ischemic stroke and diabetes with relative PAFs as 9.04%, 13.96%, 14.96%, 17.80% and 16.92%, respectively. The attribution of death on Physical activity was 388 954. The most attributed death was ischemic heart disease, followed by ischemic stroke. With the elimination of physical inactivity, the total life expectancy was expected to lose by 0.43 years, with 0.47 years in women, and 0.39 years in men. Conclusion: The increase of physical activity may benefit on health condition so to reduce the burden of chronic diseases and increase the life expectancy.

[Mortality attributable to inadequate intake of fruits among population aged 25 and above in China, 2013].

Objective: To assess the mortality attributable to low fruit intake among people over 25 years old in China, 2013, and its effect on life expectancy. Methods: Based on data collected from China Chronic Disease and Risk Factor Surveillance in 2013, the average fruit intake in different genders and areas were calculated. Potential impact fraction (PIF) was used to examine the impact on deaths, mortality and life expectancy. Results: The average daily fruit intake was (113.3±168.9) g among people over 25 years old, with (103.6±160.1) g for men and (122.7±176.6) g for women, in China in 2013. Fruit intake for urban residents was significantly higher than that in rural residents and higher in eastern regions than that in central or western regions. Scores that attributable to low fruit intake accounted for 15.21% of the total deaths and the population attributable fraction of inadequate intake of fruits to associated diseases was 35.00%. PIF for all the deaths in rural residents (16.50%) appeared higher than that of the urban residents (13.88%), and higher in the residents living in the eastern region (15.48%) than that in the central (16.27%) or western (13.75%) regions. Number of deaths that attributable to low fruit intake was 1.348 4 million. Deaths caused by related diseases appeared as: ischemic heart disease (472.5 thousands), hemorrhagic stroke (338.8 thousands), ischemic stroke (259.0 thousands), lung cancer (208.4 thousands), esophageal cancer (60.7 thousands), laryngeal cancer (5.4 thousands) and oral cancer (3.6 thousands). Numbers of all deaths and related diseases for urban residents were lower than that of the rural residents, with central regions (452.7 thousands) higher than that in the eastern (531.1 thousands) or western (364.6 thousands) regions. The average life expectancy loss caused by low fruit intake was 1.73 years, 1.80 years for men and 1.58 years for women, in this country. Loss of life expectancy in the rural residents was higher than that of the urban residents, and higher in central regions than that in the eastern or western regions. Conclusions: The intake of fruit was far lower than the recommended standard set for the Chinese people. Population attributable fraction was related to the associated diseases caused by inadequate intake of fruits which also made serious impact on life expectancy.

[Acute effect of fine particulate matters on daily cardiovascular disease mortality in seven cities of China].

Objective: To explore the effect of fine particulate matters with an aerodynamic diameter less than 2.5 µm (PM(2.5)) on daily cardiovascular disease mortality in seven cities of China. Methods: Daily average concentrations of PM(2.5), cardiovascular disease mortality data and environmental data were collected from January 1, 2013 to December 31, 2015 in seven cities of China, including Shijiazhuang, Haerbin, Shanghai, Wuhan, Guangzhou, Chengdu and Xi' an. We linked generalized additive model with Quasi-Poisson distribution to evaluate the association between daily concentrations of PM(2.5) and cardiovascular disease mortality at single-city level and multi-city level, after adjusting for the long-term and seasonal trend, as well as meteorological factors and the effect of " days of week" . Results: The single-pollutant model indicated that there were marked differences in association strength in these cities, among which the effect in Guangzhou was strongest. At multi-city level, a 10 µg/m(3) increase of PM(2.5) was associated with an increase of 0.315% (95%CI: 0.133%-0.497%) of daily cardiovascular disease mortality. From lag0 to lag2, the effect of PM(2.5) on cardiovascular disease mortality decreased, while it was strongest on lag01. In the two-pollutant model, the estimated effect decreased in all the cities with the adjustments of SO(2) or NO(2). The insignificant combined results suggested that PM(2.5) might have combined effect with other pollutants. Each 10 µg/m(3) increase of PM(2.5) was associated with increases of 0.371% (95%CI: 0.141%-0.600%) and 0.199% (95% CI: 0.077%-0.321%) of cardiovascular disease mortality in males and females, respectively. The effect of PM(2.5) on cardiovascular disease mortality increased with age and decreased with educational level, although the differences between different subgroups were insignificant. The dose-response relationship between PM(2.5) and cardiovascular disease mortality was non-linear and non-threshold, with a steeper curve at lower concentrations. Conclusion: The increases of PM(2.5) concentration can result in the increase of daily cardiovascular mortality.

Effect of vertically oriented few-layer graphene on the wettability and interfacial reactions of the AgCuTi-SiO2f/SiO2 system.

With the aim of expanding their applications, particularly when joining metals, a simple but effective method is reported whereby the surface chemical reactivity of SiO2f/SiO2 (SiO2f/SiO2 stands for silica fibre reinforced silica based composite materials and f is short for fibre) composites with vertically oriented few-layer graphene (VFG, 3-10 atomic layers of graphene vertically oriented to the substrate) can be tailored. VFG was uniformly grown on the surface of a SiO2f/SiO2 composite by using plasma enhanced chemical vapour deposition (PECVD). The wetting experiments were conducted by placing small pieces of AgCuTi alloy foil on SiO2f/SiO2 composites with and without VFG decoration. It was demonstrated that the contact angle dropped from 120° (without VFG decoration) to 50° (with VFG decoration) when the holding time was 10 min. The interfacial reaction layer in SiO2f/SiO2 composites with VFG decoration became continuous without any unfilled gaps compared with the composites without VFG decoration. High-resolution transmission electron microscopy (HRTEM) was employed to investigate the interaction between VFG and Ti from the AgCuTi alloy. The results showed that VFG possessed high chemical reactivity and could easily react with Ti even at room temperature. Finally, a mechanism of how VFG promoted the wetting of the SiO2f/SiO2 composite by the AgCuTi alloy is proposed and thoroughly discussed.

[Disease burden attributable to household air pollution in 1990 and 2013 in China].

Objective: To assess the disease burden attributable to household air pollution in 1990 and 2013 in China. Methods: Based on data from the Global Burden of Disease Study 2013 in China (GBD 2013), we used population attributable fractions (PAF) to analyze the burden of different diseases attributable to solid-fuel household pollution in 2013 in China(not inclnding HongKang, Macao, Taiwan). We compared PAF, mortality, and disability-adjusted life years (DALY) for diseases attributable to solid-fuel household pollution in 31 provinces in mainland China in 1990 and 2013, and stratified the burden by age group. The estimated world average population during 2000- 2025 was used to calculate age-standardized mortality and DALY rates. Results: In 2013, 14.9% of lower respiratory infections in children <5, 32.5% of chronic obstructive pulmonary disease (COPD), 12.0% of ischemic stroke, 14.2% of hemorrhagic stroke, 10.9% of ischemic heart disease, and 13.7% of lung cancer were attributable to solid-fuel household pollution. In addition, 807 000 deaths were attributable to solid-fuel household pollution, including 296 000 from COPD, 169 000 from hemorrhagic stroke, 152 000 from ischemic heart disease, 88 000 from ischemic stroke, 75 000 from lung cancer, and 28 000 from lower respiratory infections in children <5. The age-standardized mortality rate from solid-fuel household pollution decreased by 59.3% from 158.8/100 000 in 1990 to 64.6/100 000 in 2013. The age-standardized mortality rate from solid-fuel household pollution decreased in all 31 provinces, with the highest decline observed in Shanghai (96.3%), and lowest in Xinjiang (39.9%). In 2013, the age-standardized DALY rate from solid-fuel household pollution was highest in Guizhou (2 233.0/100 000) and lowest in Shanghai (27.0/100 000). The DALY rate was the highest for the >70 age group (7 006.0/100 000). Compared with 1990, the 2013 mortality rate and DALY rate from solid-fuel household pollution decreased in all age groups, with the highest decline observed in the <5 age group (91.9% and 91.8% , respectively). Conclusion: Although the disease burden attributable to household air pollution decreased notably between 1990 and 2013, household pollution caused a high number of deaths and DALY loss in certain western provinces.