Is the Mortality Trend of Ischemic Heart Disease by the GBD2013 Study in China Real?

To determine the reason for the different mortality trends of ischemic heart disease (IHD) for China between Global Burden of Disease (GBD) 2010 and GBD2013, and to improve garbage code (GC) redistribution. All data were obtained from the disease surveillance points system, and two proportions for assigning chronic pulmonary heart disease (PHD) as GC to IHD were from GBD2010 and GBD2013, which were different for years before 2004. By using the GBD2013 approach, the age-standard mortality rate (ASMR) increased by 100.21% in 1991, 44.81% in 1996, and 42.47% in 2000 in comparison with the GBD2010 approach. The different methods of chronic PHD redistribution impacted the trend of IHD mortality, which elevated it in the earlier 1990s by using the GBD2013 approach. Thus, improving the redistribution of GC as a key step in mortality statistics is important.

Increased lung cancer mortality rates in the Chinese population from 1973-1975 to 2004-2005: An adverse health effect from exposure to smoking.

BACKGROUND: Lung cancer incidence and mortality rates have increased substantially in China despite improvements in clinical diagnosis and treatment approaches as well as significant advances in the implementation of tobacco-control policies in recent decades. METHODS: Age-standardized mortality rates and age-specific rates of lung cancer in China were estimated for the periods 1973 to 1975, 1990 to 1992, and 2004 to 2005 using data from 3 National Death Surveys. Among patients with lung cancer who were identified from a hospital-based information system, the percentages of ever-smokers were analyzed according to histologic and demographic variables. RESULTS: Age-standardized mortality from lung cancer in China dramatically increased from 7.30 per 100,000 during 1973 through 1975 to 27.62 per 100,000 during 2004 through 2005. Increases in lung cancer age-standardized mortality were consistent among men and women in urban and rural populations. Among men ages 75 to 79 years, lung cancer mortality increased remarkably to 453.67 per 100,000 in 2004 and 2005 (from 246.78 per 100,000 during 1990-1992 and from 53.65 per 100,000 during 1973-1975). Among 6674 patients with lung cancer who were identified from 2003 to 2007 from a hospital-based database, 82.97% of men were ever-smokers (73.35% of men with adenocarcinoma and 91.8% of men with squamous cell carcinoma), and 11.18% of women were ever-smokers (6% of women with adenosquamous carcinoma and 39.02% of women with squamous cell carcinoma). Differences in the numbers of ever-smokers were observed between age groups but not according to the year of diagnosis. CONCLUSIONS: The consistent and rapid increases in lung cancer mortality rates observed in the Chinese population and the high prevalence of exposure to smoking in China prompt a strong call for the implementation of a comprehensive tobacco-control policy and specific public health educational strategies.

Spatial distribution of liver cancer incidence in shenqiu county, henan province, china: a spatial analysis.

Liver cancer is a common and leading cause of cancer death in China. We used the cancer registry data collected from 2009 to 2011 to describe the spatial distribution of liver cancer incidence at village level in Shengqiu county, Henan province, China. Spatial autocorrelation analysis was employed to detect significant differences from a random spatial distribution of liver cancer incidence. Spatial scan statistics were used to detect and evaluate the clusters of liver cancer cases. Spatial clusters were mapped using ArcGIS 10.0 software in order to identify their physical location at village level. High cluster areas of liver cancer incidence were observed in 26 villages of 7 towns and low cluster areas were observed in 16 villages of 4 towns. High cluster areas of liver cancer incidence were distributed along the Sha Ying River which is the largest of tributary of the Huai River. Role of water pollution in Shenqiu County where the high cluster was found deserves further investigation.

Histological subtypes of lung cancer in Chinese males from 2000 to 2012.

OBJECTIVE: To characterize the histological and epidemiological features of male lung cancer patients in China. METHODS: The demographic and histological information about male lung cancer patients identified from 2000-01-01 to 2012-12-31, was collected from the Cancer Hospital of the Chinese Academy of Medical Sciences. Relative frequencies (RF) were estimated for major histological subtypes and compared according to the years of diagnosis and birth. RESULTS: The RF of adenocarcinoma (ADC) increased from 21.96% to 43.36% and the RF of squamous cell carcinoma (SCC) decreased from 39.11% to 32.23% from 2000 to 2012 in the 15 427 male lung cancer patients included in this study (Z=17.909, P<0.0001; Z=-6.117, P<0.0001). The RF of ADC increased from 28.72% in 2000-2004, 36.88% in 2005-2008 to 48.61% in 2009-2012 in patients born after 1960. The age-adjusted RF of ADC in 2007-2012 increased consistently in all the investigated areas. CONCLUSION: The increased RF of ADC in male lung cancer patients highlights the need for further investigation of the etiologic factors of these tumors. Smoke-free policies rather than modifying tobacco products should be enforced.

Histological subtypes of lung cancer in Chinese women from 2000 to 2012.

BACKGROUND: The aim of the study was to characterize the histological and epidemiological features of lung cancer in Chinese women. METHODS: Demographic and histological information on female lung cancer cases identified during 1 January 2000 through 31 December 2012 from the Cancer Hospital of the Chinese Academy of Medical Sciences were collected. The International Classification of Diseases for Oncology system was used to classify the histological subtypes. Relative frequencies (RF) were estimated for major histological subtypes and compared by the years of diagnosis and birth, and among residential areas. Statistical differences were tested for RFs in the time periods with a trend test and with Pearson Chi square tests for distribution. RESULTS: Of 7070 female Chinese lung cancer cases, the major histological subtypes were adenocarcinoma (ADC) 65.79%; squamous cell carcinoma (SCC) 10.21%; small cell cancer 8.12%; large cell carcinoma, 2.79%; and adeno-squamous carcinoma (ASC), 2.19%. ADC increased, with RFs from 46.72% in the cases identified in 2000-2002 to 76.49% in 2011-2012 (Z = 16.998, P < 0.0001); SCC decreased from 15.69% to 5.97% (Z = -8.750, P < 0.0001). Compared to the cases identified in 2000-2006, the age-adjusted RFs of ADC in 2007-2012 consistently increased in all study areas. CONCLUSION: The significant increase of ADC of the lung in Chinese women suggests that a persistently strong exposure to potential carcinogens in the Chinese population should be further and fully investigated.

[Assessment of the strength of tobacco control on creating smoke-free hospitals using principal components analysis].

OBJECTIVE: To explore the relationship between the strength of tobacco control and the effectiveness of creating smoke-free hospital, and summarize the main factors that affect the program of creating smoke-free hospitals. METHODS: A total of 210 hospitals from 7 provinces/municipalities directly under the central government were enrolled in this study using stratified random sampling method. Principle component analysis and regression analysis were conducted to analyze the strength of tobacco control and the effectiveness of creating smoke-free hospitals. RESULTS: Two principal components were extracted in the strength of tobacco control index, which respectively reflected the tobacco control policies and efforts, and the willingness and leadership of hospital managers regarding tobacco control. The regression analysis indicated that only the first principal component was significantly correlated with the progression in creating smoke-free hospital (P<0.001), i.e. hospitals with higher scores on the first principal component had better achievements in smoke-free environment creation. CONCLUSIONS: Tobacco control policies and efforts are critical in creating smoke-free hospitals. The principal component analysis provides a comprehensive and objective tool for evaluating the creation of smoke-free hospitals.

[Cross-sectional survey on smoking and smoking cessation behaviors among Chinese adults in 2010].

OBJECTIVE: To describe the prevalence of smoking and smoking cessation in Chinese adults in 2010. METHODS: A face-to-face questionnaire survey was carried out in 162 surveillance points to collect information on non-communicable diseases related risk factors. Multi-stage stratified cluster random sampling method was used to select 98 712 individuals aged 18 and over to be interviewed and 98 526 records were included in the analysis of smoking and smoking cessation. Sample was weighted to represent the population of Chinese adults. Indicators such as current smoking and smoking cessation among different population were calculated. RESULTS: Current smoking rate of our sample was 26.4% (26 047/98 526). With complex weighting, current smoking rate in Chinese adults aged 18 and above was 28.3% (95%CI: 27.2% - 29.4%), which is much higher among men (53.3%, 95%CI: 51.4% - 55.2%) than in women (2.5%, 95%CI: 1.9% - 3.0%) (P < 0.05). Most male current smokers (88.3%, 95%CI: 87.3% - 89.3%) smoked every day and average daily manufacture cigarettes consumption of male adults was (17.8 ± 9.3) cigarettes. Only 14.8% (95%CI: 13.8% - 15.8%) of male ever smokers quitted smoking and 10.7% (95%CI: 9.9% - 11.5%) quitted smoking. Only 38.8% (95%CI: 36.9% - 40.8%) of male current smokers intended to quit smoking. For current smokers aged from 18 to 24, proportion of those who intended to quit smoking was highest (50.5%, 95%CI: 46.1% - 54.8%), but proportion of those who quitted smoking (7.1%, 95%CI: 5.2% - 8.9%) was lowest comparing with other age groups (P < 0.05). CONCLUSION: Prevalence of smoking in Chinese adults was high and only a few smokers quit smoking. Prevalence of smoking in Chinese male adults was still high. Fairly low proportion of male current smokers intend to quit smoking and even lower proportion of them quit smoking successfully.

Epidemiological characteristics of cancer in elderly chinese.

Background. Population of elder Chinese has been increasing, but the pattern and trend of cancer in that population was rarely reported. Methods. Mortality rates for cancer of all sites and of the site specific of the overall and elderly Chinese from 2004 to 2005 were estimated. The age structure of world population was used to observe the changes in the age-standardized mortality rates from 1975 to 2005 using the data from the national death surveys, Disease Surveillance Points, and cancer registries in China. Results. The mortalities among the elderly Chinese were 782.12 per 100,000, substantially higher than those of the people less than 60 years old. The mortalities for cancers of lung, stomach, liver, and esophagus in elderly population showed great increase compared to younger ages. Stomach cancer ranked as the second most common cancer following lung cancer in the elderly, and those two malignancies had similar mortality rates in male elderly, while in female, it ranked as first, surpassed lung cancer. Consistent decreased trends of M/I ratios of cancer were observed in all age groups. Conclusion. Strategies in cancer prevention and cost-effective preventive intervention should be highly considered and strongly implemented among the elderly Chinese.

[Geographical distribution of cancer mortality in China, 2004-2005].

OBJECTIVE: To describe geographical distribution and its transition of mortality of cancers in China. METHODS: The information of 2 513 949 310 person years were collected in 1973-1975 and 142 660 482 person years in 2004-2005 respectively. Being standardizing the death rates of these two survey with 2000 national census population, the changes of mortality of main cancers was observed and the geographic distribution of cancers in 2004-2005 was analyzed. RESULTS: A total of 1 865 445 cancer deaths were collected in 1973-1975, the standardized death rate was 99.61/100 000, and 193 839 cancer deaths were collected in 2004-2005, the standardized death rate was 123.72/100 000, with growth of 24.20%. District mortality analysis showed that the provincial standardized cancer death rates varied greatly, with the highest in Heilongjiang (7443 cases, 183.34/100 000), and the lowest in Yunnan (2454 cases, 61.03/100 000). The highest standardized death rate of esophageal cancer, gastric cancer, liver cancer, colon cancer, lung cancer, nasopharyngeal cancer, leukemia, female breast cancer, cervical cancer was in Henan (3535 cases, 32.95/100 000), Gansu (1333 cases, 59.35/100 000), Heilongjiang (1640 cases, 38.63/100 000), Shanghai (390 cases, 11.58/100 000), Heilongjiang (2382 cases, 60.15/100 000), Hainan (36 cases, 7.04/100 000), Tianjin (161 cases, 5.45/100 000), Heilongjiang (179 cases, 8.09/100 000), Xinjiang (131 cases, 10.69/100 000) respectively; the lowest standardized cancer death rate of above-mentioned cancers was in Yunnan (63 cases, 1.59/100 000), Beijing (235 cases, 5.95/100 000), Tianjin (454 cases, 10.86/100 000), Tibet (3 cases, 0.82/100 000), Tibet (12 cases, 3.29/100 000), Qinghai (0 case, 0.00/100 000), Tibet (1 cases, 0.28/100 000), Tibet (6 cases, 2.88/100 000), Chongqing (27 cases, 1.02/100 000) respectively. CONCLUSION: Comparing the two surveys, the standardized mortality of cancers was increased. Most of cancers occurred obviously in cluster by geographical distribution.

[Body mass index and mortality from ischaemic heart disease in China: a 15-year prospective study on 220 000 adult men].

OBJECTIVE: To assess the relationship between body mass index (BMI) and ischaemic heart disease (IHD) mortality, especially in populations with low mean BMI levels. METHODS: We examined the data from a population-based, prospective cohort study of 220 000 Chinese men aged 40 - 79, who were enrolled in 1990 - 1991, and followed up ever since to 1/1/2006. Relative risks of the deaths from IHD by the baseline BMI were calculated, after controlling age, smoking, and the other potential confounding factors. RESULTS: The mean baseline BMI was 21.7 kg/m(2), and 2763 IHD deaths were recorded during the 15-year follow-up (6.8% of all deaths) program. Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. When baseline BMI was above 20 kg/m(2), there was a strongly positive association of BMI with IHD risk, with each 5 kg/m(2) higher in BMI associated with 21% (95%CI: 9% - 35%, P = 0.0004) higher IHD mortality. Below this BMI range, the association appeared to be reverse, with the risk ratios as 1.00, 1.11, and 1.14, respectively, for men with BMI 20 - 21.9, 18 - 19.9, and < 18 kg/m(2). The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up. CONCLUSION: Lower BMI was associated with lower IHD risk among people in the so-called 'normal range' of BMI values (20 - 25 kg/m(2)). However, below that range, the association might well be reversed.

Estimation of cancer incidence and mortality attributable to smoking in China.

BACKGROUND: Tobacco smoking, as a cause of cancer, is common in China. Few studies have been conducted to assess the burden of tobacco-related cancer in the Chinese population. METHODS: We calculated the proportion of cancers attributable to tobacco smoking to estimate the burden of tobacco-related cancer. Population attributable fraction was calculated based on the assumption of total avoidance of smoking. Data on smoking prevalence were from two large-scale national surveys of representative samples of the Chinese population. Data on relative risk were derived from the meta-analyses and large-scale studies. Cancer mortality and incidence were originated from the third national death cause survey and cancer registries in China. RESULTS: We estimated that a total of 405,112 deaths of cancer were attributable to smoking in China in 2005, including 372,264 among men (32.7% of all cancer deaths) and 32,848 among women (5.0%). A total of 495,221 cancer cases were attributable to smoking, including 454,785 among men (30.0% of all cancer cases) and 40,436 among women (3.9%). Involuntary smoking was responsible for 11,507 lung cancer deaths (11.1%) among non-smoking women. CONCLUSION: Tobacco smoking is responsible for one-third of the total cancer deaths among men. Involuntary smoking is an important individual risk factor for lung cancer among non-smoking women. There is a need to continue and strengthen tobacco-control programs and initiatives to reduce smoking-related cancer burden in China.

Findings from 2010 Global Adult Tobacco Survey: implementation of MPOWER policy in China.

OBJECTIVE: To assess the implementation of five key tobacco control policies in China: protection from second-hand smoke (SHS); offering help to quit; health warnings regarding tobacco use; the enforcement of bans on tobacco advertising, promotion, and sponsorship; and increasing tobacco taxes and prices. METHODS: Using 2010 Global Adults Tobacco Survey in China (GATS-China), 10 indicators are used to assess the implementation of five key tobacco control policies of MPOWER in China. RESULTS: Overall, 63.3% and 72.7% of adults noticed people smoking indoor workplaces and public places, respectively. Approximately 60% of smokers were not asked about their smoking habits and approximately 67% were not advised to quit on their visit to a health worker. Sixty percent of adults noticed health warning messages on cigarette packaging and in the media in the last 30 days, 63.6% stated that they would not consider quitting. Twenty percent of respondents noticed tobacco advertising, promotion, and/or sponsorship activities in the 30 days prior to the survey. Among them, 76.3% noticed the direct advertising and 50% noticed from TV programs. Although purchasing price of one pack of cigarettes ranged from 1 to 200 RMB, 50% of current smokers (about 150 million) spent 5 RMB or less on one pack of cigarette. The expenditure on 100 packets of cigarettes represents 2% of 2009 GDP per capita. CONCLUSION: The average score for the implementation of the 5 policies of MPOWER in China is 37.3 points, indicating tobacco control policies in China is poor and there is a large gaps from the FCTC requirements.

Population-based survey of secondhand smoke exposure in China.

OBJECTIVE: To determine the extent of secondhand smoke exposure in China, and to explore the potential associated factors. METHODS: This study was a nationally representative household survey examining secondhand smoke exposure of non-institutionalized men and women aged 15 and older using a global standardized geographically clustered sample design. A total of 13,354 people completed the individual questionnaire with questions on gender, age, educational level, residence, profession, potential factors associated with secondhand smoke exposure, and workplace smoking policy. The data were used to determine whole population estimates of secondhand smoke exposure. RESULTS: Among non-smokers aged 15 years and older, it was estimated that 72.4% (556 million) were exposed to secondhand smoke, with 52.5% (292 million) exposed to secondhand smoke daily. The prevalence of secondhand smoke exposure was 74.1% for men, 71.6% for women, 70.5% for urban populations, and 74.2% for rural populations. The rates were 67.3%, 63.3%, and 72.7% respectively, within the household, indoor workplaces and public places. Secondhand smoke exposure was significantly reduced in workplaces with a smoking ban but not in workplaces with a partial smoking ban. CONCLUSION: Although China has made some progress toward a smoke-free environment there remains a high degree of exposure to secondhand smoke.

Awareness of tobacco-related health hazards among adults in China.

OBJECTIVE: To determine the level of awareness of the hazards of tobacco smoking and secondhand smoke inhalation among adults in China. METHODS: Household surveys were conducted with a total of 13,354 respondents aged 15 years or over from 100 counties of 28 Chinese provinces using a stratified multi-stage geographically clustered sample design. RESULTS: The findings revealed that 81.8% of the population was aware that smoking causes serious diseases, and 27.2% and 38.7% were aware that smoking causes stroke and heart attack, respectively. Only 64.3% of respondents were aware that secondhand smoke can cause serious diseases, and 27.5%, 51.0%, and 52.6% were aware that secondhand smoke causes heart disease in adults, lung disease in children and lung cancer in adults, respectively. Awareness regarding smoking-related hazards across all participants was significantly associated with several factors, including gender, smoking status, urban/rural residency, education level and exposure to tobacco control publicity in the last 30 days. Awareness regarding tobacco-related hazards in smokers was significantly associated with urban/rural residency, education level, exposure to tobacco control publicity in the last 30 days, and physician's advice. Awareness relating to the hazards of inhaling secondhand smoke was associated with smoking status, urban/rural residency, age, education level, and exposure to tobacco control publicity in the last 30 days. Medical professionals were found to know more about the health hazards of tobacco compared with people in other types of employment. CONCLUSIONS: Overall awareness of the health hazards of tobacco has improved in the last 15 years in China, but is still relatively poor. Improved means of communicating information and more effective warning labels on cigarette packaging are necessary for increasing public awareness of tobacco hazards, particularly among rural residents and people with less education.

[Factors associated with attitudes toward tobacco control policy in public places among adults in three counties of China].

OBJECTIVE: vestigate the attitudes of urban and rural community members toward total banning on smoking in public places and to explore the factors associated with these attitudes, in three counties/cities in China. METHODS: A cross-sectional study was conducted in three counties/cities in 2004, including Xin' an county of Henan province, Anyi county of Jiangxi province, and Mianzhu city of Sichuan province. A total of 5642 residents at age of 18-69 years old were interviewed face-to-face with a uniform questionnaire by locally-trained interviewers, through a random three-stage stratified sampling in each county. Factors were assumed to be associated with attitudes, using chi-square test in univariate analysis and non-conditional logistic regression model in multivariate analysis. RESULTS: The prevalence of current smoking among respondents was 44.3%. 80.7% (1379/1709) of the current smokers reported smoking often or sometimes in public places. Only 9.6% (479/4983) of the respondents reported that their indoor workplaces had totally banned on smoking. 43.5% of the respondents supported a total smoking ban strategy in pubic venues. The results of multivariate logistic regression model showed that eight factors were significantly associated with support for the total smoking ban in public places included region, residency, age, gender, education, smoking status, awareness about passive smoking hazards, and hearing of any message on tobacco control through media differences of rates regarding the factors as: residents in urban to rural areas (OR = 1.29), elderly to youngsters (30-49 vs. 18-29, OR = 1.46; 50-69 vs. 18-29, OR = 1.71), female to male (OR = 1.27), high-educated to less-educated ones, quitters to current smokers (OR = 1.90), nonsmokers to current smokers (OR = 2.01). Those who know messages on health hazards of passive smoking (OR = 2.26), or heard of message on tobacco control through media (OR = 1.43). CONCLUSION: Results from our study revealed that a thorough smoke-free policy in public places should be developed and implemented in these three counties/cities.

[What is the prevalence of smoking in China].

OBJECTIVE: To determine the accuracy of prevalence data sets on tobacco use so as to measure the risk of tobacco use and the impact of tobacco control in China. METHODS: Three published data sets on nation-wide survey were reviewed and compared. Two principles were applied to determine the accuracy of the data on prevalence: i ) The estimated consumption of cigarettes based on the current prevalence rate on smokers should have been close to the actual cigarette consumption level; ii) change on the annual prevalence of male current smokers should be around 1% in China, since the international experience on the prevalence of current smokers tended to decrease at a rate of around 1% per year in the presence of comprehensive tobacco control strategies. RESULTS: The differences between the estimated cigarette consumption and the actual cigarette consumption for the three surveys were 51.07 billion through Behavior Risk Factor Surveillance System (BRFSS 2002), 62.94 billion through the Chinese Citizen Nutrition & Health Survey (CCNHS 2002), and 217.11 billion through the China Health Service Survey (CHSS 2003). In comparison with the national tobacco use survey in 1996, the prevalence of male current smokers apparently dropped by 0.9% in BRFSS 2002, 2.2% in CCNHS 2002 and 2.0% per year in CHSS 2003. Thus, the prevalence of current smokers in BRFSS (2002) was more reliable, comparing to the results from the other two surveys. CONCLUSION: The prevalence of current smokers as determined by the BRFSS should be used to reflect the epidemic of tobacco use when implementing the FCTC in China. However, the reporting prevalence rates of tobacco use were different in the different surveys regarding tobacco use, suggesting that the capacity of surveillance on tobacco control should be strengthened, including the standardization of definitions on 'ever-smoker' and 'current smoker' , as well as on standardized questionnaire, sampling strategy and the process of data analysis, quality of field work etc. Precise estimation of prevalence appears to be the key point for understanding how many current smokers so as to develop control policy, including setting up 'quit' clinics and evaluating the impact of tobacco control programs. There is an urgent need to establish a national standardized surveillance system to monitor the tobacco epidemics.