Changing spectrum and mortality disparities of etiology of liver cirrhosis in Beijing, China.

Liver cirrhosis remains a major health concern globally, but its epidemiology and etiology evolve with time. However, the changing pattern in etiology and cause of liver-related mortality for patients with cirrhosis are not fully elucidated. Herein, our aim was to characterize the temporal trend of the etiological spectrum and evaluate the impact of etiology on liver-related death among patients with compensated cirrhosis (CC) in Beijing, China. Clinical profiles of patients with CC discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. The mortalities of different etiologies of cirrhosis were calculated. The risks of readmission and liver-related death associated with etiologies were evaluated by the Cox regression model. A total of 23 978 cirrhotic patients were included. The predominant cause was hepatitis B virus (HBV) (58.93%), followed by alcohol (21.35%), autoimmune (14.85%), miscellaneous etiologies (3.55%), and hepatitis C virus (HCV) (1.32%). From 2008 to 2015, the proportion of HBV-related cirrhosis decreased to 28.11%. Meanwhile, the proportions of autoimmune- and miscellaneous-related cirrhosis increased to 28.54% and 13.11%. The risk of liver-related death ranked the highest in patients with miscellaneous cirrhosis, followed by HBV-related cirrhosis, alcohol-related cirrhosis, autoimmune-related cirrhosis, and HCV-related cirrhosis. The 5-year rates of liver-related death were 22.56%, 18.99%, 18.77%, 16.01%, and 10.76%, respectively. HBV-related cirrhosis caused the highest risk of hepatocellular carcinoma (HCC)-related death, whereas alcohol- and miscellaneous-related cirrhosis caused higher risks of decompensation (DC)-related death than HBV-related cirrhosis, with hazard ratios of 1.35 (95% confidence interval [CI]: 1.24-1.48) and 1.20 (95% CI: 1.03-1.40), respectively. HBV remained a common cause of liver cirrhosis but gradually decreased. Mortality disparities existed in etiologies, with higher risks of HCC-related death in HBV-related cirrhosis, and DC-related death in alcohol- and miscellaneous-related cirrhosis.

Prevalence of Metabolic Syndrome and Risk Factors Among Chinese Adults: Results from a Population-Based Study - Beijing, China, 2017-2018.

What is already known about this topic?: Metabolic syndrome (MetS) is one of the most easily available health indicative markers for cardiovascular diseases, and it has become a major public health problem worldwide due to increasing urbanization and aging populations. The prevalence of MetS increased dramatically in China, however, there are no records of MetS defined by the 2017 Chinese Diabetes Society for Beijing by far. What is added by this report?: In this study, the data of 24,412 participants aged 18-74 years from a large population-based study in Beijing was collected. The overall prevalence of MetS among Beijing residents was 24.5%. The prevalence was 35.2% in males and 15.4% in females. What are the implications for public health practice?: Effective public health strategies should target males, people with older age, lower education, higher body mass index, smokers, those who drink alcohol, those who are unemployed or retired, and those who live in rural areas on MetS prevention and control.

Interruption of Influenza Transmission under Public Health Emergency Response for COVID-19: a Study Based on Real-World Data from Beijing, China.

To estimate the effect of the corona virus disease 2019 (COVID-19) control measures taken to mitigate community transmission in many regions, we analyzed data from the influenza surveillance system in Beijing from week 27 of 2014 to week 26 of 2020. We collected weekly numbers of influenza-like illness (ILI) cases, weekly positive proportion of ILI cases, weekly ILI case proportion in outpatients, and the dates of implementation of COVID-19 measures. We compared the influenza activity indicators of the 2019/2020 season with the preceding five seasons and built two ARIMAX models to estimate the effectiveness of COVID-19 measures declared since January 24, 2020 by the emergency response. Based on the observed data, compared to the preceding five influenza seasons, ILIs, positive proportion of ILIs, and duration of the influenza epidemic period in 2019/2020 had increased from 13% to 54%; in particular, the number of weeks from the peak to the end of the influenza epidemic period had decreased from 12 to 1. According to ARIMAX model forecasting, after considering natural decline, weekly ILIs had decreased by 48.6%, weekly positive proportion had dropped by 15% in the second week after the emergency response was declared, and COVID-19 measures had reduced by 83%. We conclude that the public health emergency response can significantly interrupt the transmission of influenza.

Associations of long-term exposure to air pollution with blood pressure and homocysteine among adults in Beijing, China: A cross-sectional study.

BACKGROUND: Studies on the hypertensive effect of long-term exposure to air pollution are mixed, and sparse evidence exists regarding its effects on homocysteine (Hcy), another crucial risk factor for cardiovascular disease (CVD). METHODS: We collected data from 23,256 participants aged 18-74 years at baseline (years 2017-2018) from a community-based cohort in China. A linear combination of concentrations from monitoring stations at the participants' home and work addresses, weighted by the time, was used to estimate two-year exposures to particulate matter with fine particles≤2.5 µm (PM2.5), aerodynamic diameter≤10 µm (PM10), nitrogen dioxide (NO2) and sulfur dioxide (SO2). Generalized linear regressions and logistic regressions were conducted to examine the associations between air pollution and systolic blood pressure (SBP), diastolic blood pressure (DBP), Hcy, hypertension and co-occurrence of hypertension and hyperhomocysteinemia (HHcy). RESULTS: The results showed that each interquartile range (IQR) increase in PM2.5 (16.1 µg/m3), PM10 (19.3 µg/m3) and SO2 (3.9 µg/m3) was significantly associated with SBP (changes: 0.64-1.86 mmHg), DBP (changes: 0.35-0.70 mmHg) and Hcy (changes: 0.77-1.04 µmol/L) in the fully adjusted model. These air pollutants were also statistically associated with the prevalence of co-occurrence of hypertension and HHcy (ORs: 1.22-1.32), which were stronger than associations with the prevalence of hypertension (ORs: 1.09-1.19). The hypertensive effects of exposure to PM2.5, PM10 and SO2 were more pronounced among elder participants, obese participants, those with established CVD or a high 10-year CVD risk and those with a family history of hypertension. However, interaction analyses of Hcy showed different patterns. Additionally, moderate level of physical activity and active travel mode benefited individuals in resisting the health impacts of air pollution on both blood pressure (BP) and Hcy. CONCLUSIONS: Our study supports a positive relationship between air pollution and BP and Hcy among adults in Beijing, and close attention to vulnerable populations and healthy lifestyles could effectively benefit further cardiovascular health.

Influenza-associated cardiovascular mortality in older adults in Beijing, China: a population-based time-series study.

OBJECTIVE: This study comprehensively estimated the excess cardiovascular disease (CVD) mortality attributable to influenza in an older (age ≥65 years) population. DESIGN: Ecological study. SETTING: Aggregated data from administrative systems on CVD mortality, influenza surveillance and meteorological data in Beijing, China. MAIN OUTCOME MEASURE: Excess overall CVD, and separately for ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke mortality attributable to influenza, adjusting for influenza activity, time trend, seasonality and ambient temperature. RESULTS: CVD (risk ratio (RR) 1.02, 95% CI 1.01, 1.02), IHD (RR 1.01, 95% CI 1.01, 1.02), ischaemic stroke (RR=1.03, 95% CI 1.02, 1.04), but not haemorrhagic stroke (RR=1.00, 95% CI 0.99, 1.01) mortality, were significantly associated with every 10% increase in influenza activity. An increase in circulating A(H1N1)09pdm, A(H3N2) and B type virus were all significantly associated with CVD and ischaemic stroke mortality, but only A(H3N2) and B type virus with IHD mortality. The strongest increase in disease mortality was in the same week as the increase in influenza activity. Annual excess CVD mortality rate attributable to influenza ranged from 54 to 96 per 100 000 population. The 3%-6% CVD mortality attributable to influenza activity was related to an annual excess of 916-1640 CVD deaths in Beijing, China. CONCLUSIONS: Influenza activity has moderate to strong associations with CVD, IHD and ischaemic stroke mortality in older adults in China. Promoting influenza vaccination could have major health benefit in this population. BACKGROUND: Influenza may trigger serious CVD events. An estimation of excess CVD mortality attributable to influenza has particular relevance in China where vaccination is low and CVD burden is high. METHODS: This study analysed data at the population level (age ≥65 years) using linked aggregated data from administrative systems on CVD mortality, influenza surveillance and meteorological data during 2011 to 2018. Quasi-Poisson regression models were used to estimate the excess overall CVD, and separately for IHD, ischaemic stroke, haemorrhagic stroke mortality attributable to influenza, adjusting for influenza activity, time trend, seasonality and ambient temperature. Analyses were also undertaken for influenza subtypes (A(H1N1)09pdm, A(H3N2) and B viruses), and mortality risk with time lags of 1-5 weeks following influenza activity in the current week.

A new method to estimate the temperature-CVD mortality relationship.

Few detailed, individual-focused studies have researched the added effect of temperature on cardiovascular disease (CVD), particularly in China. Moreover, no prior studies have explored the exposure-response relationship among all populations and different sub-sociodemographic groups. A distributed lag nonlinear model (DLNM) was applied to evaluate the adverse health effects of temperature on CVD mortality for all populations and different sub-sociodemographic groups (by age, sex, educational level, living arrangement, and occupation) in Beijing. Based on the exposure-response relationships, firstly, we proposed a new model (COCKTAIL, Code Of Climate Key To An Ill) for revealing the split-and-merge relationships of the temperature-CVD mortality curve. This method could be used to apply the CVD deaths in a studied area to forecast the exposure-response relationships in the same area in the future. Secondly, this is the most detailed study to analyze the relationship between temperature and CVD mortality for different subgroups among the existing researches for developed and developing countries. We found that the cold temperature (at - 14 °C) was the risk factor for people with low socioeconomic status, especially for single people (including unmarried, divorced, and widowed), for indoor workers, and for people with low education, compared with the minimum mortality temperature, with a cumulative increase of 3.9 (80%CI, 2.9-5.4), 3.8 (80%CI, 2.8-5.1), and 4.5 (80%CI, 3.1-6.3) times respectively. Meanwhile, the hot temperature (at 35 °C) was the risk factor for CVD death, with a cumulative increase of 2.6 (80%CI, 2.0-3.4) for females, and 3.1 (80%CI, 2.4-4.2) for single people. The varying CVD vulnerability in terms of CVD mortality among various groups may assist governments in preparing health resources and taking measures to prevent or reduce temperature-related deaths.

Acute Effects of Particulate Air Pollution on Ischemic Stroke and Hemorrhagic Stroke Mortality.

Background and Purpose: A large body of literature reported the association of particulate matter (PM) with stroke in high-income countries. Few studies have examined the association between PM and stroke in middle- and low-income countries and considered the types of stroke. In this study, we examined the short-term effects of particulate matter <2.5 µm in diameter (PM2.5) and particulate matter <10 µm in diameter (PM10) on ischemic stroke mortality and hemorrhagic stroke mortality in Beijing, China. Methods: We used an ecological study design and quasi-Poisson generalized additive models to evaluate the association of PM2.5 and PM10 and cerebrovascular diseases mortality, as well as ischemic- and hemorrhagic stroke mortality. In the model, we controlled long-term and season trends, temperature, and relative humidity, the day of the week and air pollution. For cerebrovascular diseases mortality, we examined the effects stratified by sex and age with different lag days. Results: A total of 48,122 deaths for cerebrovascular disease (32,799 deaths for ischemic stroke and 13,051 deaths for hemorrhagic stroke) were included in the study. PM2.5 was associated with stroke mortality. The 10 µg/m3 increase of PM2.5 was associated with the increase of mortality, 0.27% (95% CI, 0.12-0.43%) for cerebrovascular diseases, 0.23% (95% CI, 0.04-0.42%) for ischemic stroke and 0.37% (95% CI, 0.07-0.67%) for hemorrhagic stroke -. The associations between PM10 and mortality were also detected for cerebrovascular diseases and ischemic stroke, but not in hemorrhagic stroke. The stratified analysis suggested age and gender did not modify the effects of PM on mortality significantly. Conclusions: Our study suggested that short-term exposure to ambient PM was associated with the risk of stroke mortality.

Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007-2013.

BACKGROUND: Data about influenza mortality burden in northern China are limited. This study estimated mortality burden in Beijing associated with seasonal influenza from 2007 to 2013 and the 2009 H1N1 pandemic. METHODS: We estimated influenza-associated excess mortality by fitting a negative binomial model using weekly mortality data as the outcome of interest with the percent of influenza-positive samples by type/subtype as predictor variables. RESULTS: From 2007 to 2013, an average of 2375 (CI 1002-8688) deaths was attributed to influenza per season, accounting for 3% of all deaths. Overall, 81% of the deaths attributed to influenza occurred in adults aged ≥65 years, and the influenza-associated mortality rate in this age group was higher than the rate among those aged <65 years (113.6 [CI 49.5-397.4] versus 4.4 [CI 1.7-18.6] per 100 000, P < .05). The mortality rate associated with the 2009 H1N1 pandemic in 2009/2010 was comparable to that of seasonal influenza during the seasonal years (19.9 [CI 10.4-33.1] vs 17.2 [CI 7.2-67.5] per 100 000). People aged <65 years represented a greater proportion of all deaths during the influenza A(H1N1)pdm09 pandemic period than during the seasonal epidemics (27.0% vs 17.7%, P < .05). CONCLUSIONS: Influenza is an important contributor to mortality in Beijing, especially among those aged ≥65 years. These results support current policies to give priority to older adults for seasonal influenza vaccination and help to define the populations at highest risk for death that could be targeted for pandemic influenza vaccination.

Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality.

OBJECTIVE: To assess the relationship between fine particulate matter (PM2.5) concentration and ischaemic heart disease (IHD) morbidity and mortality. METHODS: A time-series study conducted in Beijing from 1 January 2010 to 31 December 2012. Data on 369,469 IHD cases and 53,247 IHD deaths were collected by the Beijing Monitoring System for Cardiovascular Diseases, which covers all hospital admissions and deaths from IHD from Beijing's population of 19.61 million. RESULTS: The mean daily PM2.5 concentration was 96.2 µg/m(3) with a range from 3.9 to 493.9 µg/m(3). Only 15.3% of the daily PM2.5 concentrations achieved WHO Air Quality Guidelines target (25 µg/m(3)) in the study period. The dose-response relationships between PM2.5 and IHD morbidity and mortality were non-linear, with a steeper dose-response function at lower concentrations and a shallower response at higher concentrations. A 10 µg/m(3) increase in PM2.5 was associated with a 0.27% (95% CI 0.21 to 0.33%, p<2.00×10(-16)) increase in IHD morbidity and a 0.25% (95% CI 0.10 to 0.40%, p=1.15×10(-3)) increase in mortality on the same day. During the 3 years, there were 7703 cases and 1475 deaths advanced by PM2.5 pollution over expected rates if daily levels had not exceeded the WHO target. CONCLUSIONS: PM2.5 concentration was significantly associated with IHD morbidity and mortality in Beijing. Our findings provide a rationale for the urgent need for stringent control of air pollution to reduce PM2.5 concentration.

[Decomposition of life expectancy among permanent residents of Beijing, 2000 - 2010].

OBJECTIVE: To analyze the change of life expectancy and the impact of mortality by age and causes of death on this issue among permanent residents of Beijing. METHODS: Abridged Life Table and Arriaga method were used to calculate and to decompose the changes on life expectancy by age and causes of death in 2000 - 2010. RESULTS: From 2000 - 2010, life expectancy under this studied population had an increase of 3.35 years. Most part of the increases (44.27%, 1.48 years) within the last 10 years could be explained by the decrease of mortality in the population at age ≥ 80. Both cerebrovascular and heart diseases were contributing the most to the increment of life expectancy while mortality of malignant tumors appeared a negative contributor to this increment. CONCLUSION: From 2000 to 2010, increment in life expectancy contributed to the decrease of mortality in the elderly and the decrease of mortalities on both cardio- and cerebro-vascular diseases. The decrease of life expectancy was mainly due to the increase of mortality related to malignant tumors.

[The epidemiology of out-of-hospital deaths due to acute coronary events in young Beijing adults].

OBJECTIVES: To explore the characteristics of status and different populations of prehospital death associated with acute coronary events among young adults in Beijing. METHODS: Data of acute coronary events of hospitalization or death were obtained from the Hospital Discharge Information System from Beijing Public Health Information Center and Death Register System from Beijing Center for Disease Control in Beijing. The total case fatality rate of acute coronary events and proportion of prehospital coronary heart disease (CHD) death were compared upon gender, area, occupation and marital status among people aged between 25 - 45 years old. RESULTS: A total of 3489 cases were identified during 2007 to 2009 with acute coronary events (male: 3183, female: 306), with a mean age of (40.5 ± 4.3) years old. The 3-years' overall mortality was 26.0%, with female's higher than male's (51.0% vs 23.6%, P < 0.05); and it was higher in rural area than in urban areas (28.9% vs 22.9%, P < 0.05). Ninety-five percent of death due to acute coronary events occurred prehospital, with the proportion of 95.2% in male and 94.2% in female. Among the people with different occupations, self-employed people had the highest rate of prehospital death. Majority of prehospital deaths (64.8%) occurred at home. CONCLUSION: More than 90% of deaths caused by acute coronary events among young adults aged between 25-45 years old occurred before been admitted into hospital, and the site of prehospital deaths was mainly at home.

[Surveillance on the incidence of acute coronary events in the permanent residents of Beijing aged 25 years and more from 2007 to 2009].

OBJECTIVE: To survey the incidence of acute coronary events and its trend in three years, and explore the distribution of the incidence across Beijing residents aged 25 years and more from 2007 to 2009. METHODS: The present study incorporated and linked the routinely collected data from the Hospital Discharge Information System and Cause of Death Register System in Beijing, estimated the incidence of acute coronary events, and analyzed the distribution of the incidence across gender, age groups and regions. Acute coronary event was defined as non-fatal myocardial infarction and death from coronary heart disease. Numbers of residents by age, gender and area were obtained from the Beijing Statistics Bureau. RESULTS: A total of 68 390 acute coronary events were identified among permanent residents of Beijing aged 25 years and more from 2007 to 2009. The age-standardized incidence was 166.4 per 100 000 people in overall population, with 218.5 in males and 115.2 in females. The age-standardized incidence was 144.3, 154.7, and 195.8 per 100 000 people in urban, suburban, and exurban area, respectively. The incidence was the highest in Huairou district (263.8 per 100 000), while was the lowest in Haidian district (121.5 per 100 000). The age-standardized incidence was 158.4, 169.4, and 171.2 per 100 000 in 2007, 2008, and 2009, respectively. The age-standardized incidence increased by 8.1% in 2009 compared to 2007, increase in men (11.1%) was greater than in women (2.5%). The incidence increased significantly with age in each year. The incidence raised by 30.3% in 2009 compared to 2007 for men aged 35 - 44 years. In 2009, the incidence was 146.7, 155.9, and 207.4 per 100 000 people in urban, suburban, and exurban area, respectively. The rates increased by 3.2% in both urban and suburban areas, and 16.4% in exurban areas in 2009 compared to 2007. CONCLUSION: The incidence of acute coronary events increased from 2007 to 2009 among the permanent residents of Beijing aged 25 years and over, especially in young men, and people living in the exurban areas.

[Characteristics of out-of-hospital acute coronary heart disease deaths of Beijing permanent residents at the age of 25 or more from 2007 to 2009].

OBJECTIVE: To analyze the characteristics of out-of-hospital acute coronary heart disease (CHD) deaths in Beijing permanent residents at the age of 25 or more from 2007 to 2009. METHODS: We analyzed the gender, age, geographical distribution, occupation, marital status and the extent of different education characteristics of out-of-hospital acute CHD deaths of the Beijing permanent residents at the age of 25 or more from 2007 to 2009 using the mortality information database from the Beijing Vital Registration Monitoring System. RESULTS: Of the total 41 732 acute CHD deaths, 30 159 (72.27%) died out of hospital and out-of-hospital mortality was 2.61 times higher than in-hospital mortality. Majority out-of-hospital death occurred in males (72.30%, 16 068/22 224), in 25 - 34 years old people (91.75%, 89/97), in residents living in remoter suburbs and counties (82.43%, 13 513/16 393), in rural population (89.50%, 10 017/11 192), in non-marital single (80.76%, 592/733) and in people less than five-years of schooling (83.95%, 11 388/13 565). Most out-of-hospital acute CHD death occurred at home (78.80%, 23 765/30 159). CONCLUSIONS: Out-of hospital acute CHD mortality is high in Beijing permanent residents at the age of 25 and over from 2007 to 2009. Male, 25 - 34 years old, living in outer suburbs and counties, rural population, non-marital single, and less education years are major risk factors for out-of-hospital acute CHD death.

[Analysis of the quality of notifiable infectious disease report in Beijing medical treatment organizations].

OBJECTIVE: To evaluate the quality of the infectious diseases reporting via network in Beijing hospitals and to filtrate factors that affect the reporting quality. METHODS: We collected 5536 infectious disease cases randomly and investigated 52 medical treatment organizations. Information was collected by field questionnaire survey, interview and gathering routine reporting data for analyzing the quality. RESULTS: The result showed that the timeliness of the 52 medical treatment organizations was 94.18%, the consistency was 80.84%, the completeness was 88.47%, and the misreport was 13.73%. The reporting quality of the second level hospitals was higher than that of the first level hospitals, township health centers and the third level hospitals. The reporting quality of urban hospitals was higher than that of the suburb hospitals. The reporting quality of outpatient and inpatient departments was higher than that of the laboratory. The laboratory was the primary part of underreporting. CONCLUSION: Strengthening guidance, training and paying attention to each weak portion would certainly ameliorate the quality of infectious diseases reporting via network.

[Impact of ageing and related factors on death rate of diabetes mellitus in Beijing].

OBJECTIVE: To analyze the ageing and related risk factors affecting the death rate of diabetes mellitus in Beijing, and make a correct assessment of risk factors in changing the death rate of diabetes mellitus. METHOD: The changes of death rate on diabetes mellitus in the past 10 years, from 1991 to 2000 were analyzed and calculated as to making clear what is the effects resulting from the ageing and the risk factors. RESULTS: The death rate of diabetes mellitus was increased to 117.55%, from 1991 to 2000, in which 53.28% were attributing to the ageing and 46.72% to the risk factors. CONCLUSION: The effects of ageing and risk factors on death rate of diabetes mellitus should be different and the ageing should be a factor more important than the other risk factors.