Cross-sectional study on prevalence and risk factors for falls among the elderly in communities of Guangdong province, China.

OBJECTIVE: This study aims to investigate the prevalence and risk factors of falls among the elderly in Guangdong, China. METHODS: A cross-sectional study was conducted in six communities of Guangdong province. People over 60 years old were selected with multistage random-cluster sampling. Data on falls within the previous 12 months and fall-related risk factors were collected through a face-to-face interview. RESULTS: The prevalence of falls among older adults was 11.9% (95% CI: 11.0% to 12.8%) among 5374 interviewees. The common injuries caused by falls were bruises/scrapes (40.0%) and fractures (15.5%), and most people fall while doing housework (35.0%). Univariate analysis showed that 14 factors were associated with falls among older adults, including gender, age, residence, occupation, education level, balance ability, situation of cognition, disease, depression, living arrangement, marital status, the behaviour of exercise, drinking and drug use (p<0.05). Multivariate analysis showed that the associated factors of falls among older adults included woman (OR=1.68, 95% CI: 1.40 to 2.02), age from 70 to 79 years (OR=1.31, 95% CI: 1.09 to 1.58), age over 80 (OR=1.63, 95% CI: 1.25 to 2.13), impaired balance ability (OR=1.45, 95% CI: 1.20 to 1.75), exercise several times per month (OR=1.69, 95% CI: 1.13 to 2.53), polypharmacy (OR=1.54, 95% CI: 1.19 to 2.00), cognition impairment (OR=1.35, 95% CI: 1.08 to 1.69), mild depression (OR=1.89, 95% CI: 1.47 to 2.45) and moderate depression (OR=3.07, 95% CI: 1.99 to 4.73). CONCLUSIONS: The hazards caused by falls to the elderly in China cannot be ignored. A multidimensional customised fall prevention programme should be considered to reduce the risk of falls among the elderly based on the results above.

Trends and external causes of traumatic brain injury and spinal cord injury mortality in south China, 2014-2018: an ecological study.

BACKGROUND: The epidemiological evidence of traumatic brain injury (TBI) and spinal cord injury (SCI) mortality in mainland China is lacking. We aimed to assess the trends of TBI and SCI mortality, and their association with sex, age, location and external causes of injury in south China. METHODS: Mortality data were derived from the Disease Surveillance Points (DSPs) system of Guangdong province between 2014 and 2018. We examined the trends in mortality with Cochran-Armitage trend test, and the association between the socio-demographic factors and the TBI and SCI mortality by using negative binomial models. Subgroup analysis was performed by stratifying the external causes of TBI and SCI. RESULTS: The age-standardized TBI mortality remained relatively stable (from 11.6 to 15.4 per 100,000), while the SCI mortality increased by 148.3% from 2014 to 2018. Compared with females and urban residents, the adjusted mortality rate ratios of males and rural residents were 2.3 and 2.0 for TBI, and 2.2 and 4.6 for SCI, respectively. TBI and SCI mortality increased substantially with age. Motor vehicle crashes and falls were the leading causes of TBI mortality in residents aged under 75 years and over 75 years, respectively. Falls were the most important external cause for SCI death of all ages. CONCLUSIONS: Being male, rural and elderly residents are at higher risk of dying from TBI and SCI. The substantial burden of TBI and SCI caused by road traffic crashes and falls has called for the urgent need to improve injury prevention, pre-hospital aid, hospital treatment and recovery.

Hypertension prevalence, awareness, treatment, control and associated factors in a developing southern Chinese population: analysis of serial cross-sectional health survey data 2002-2010.

BACKGROUND: The aim of this study was to investigate trends in the distribution, prevalence, awareness, treatment, and control of hypertension in a Chinese population that has had the fastest growing gross domestic product in the world over the past 3 decades. METHODS: Four standardized cross-sectional health surveys were conducted between 2002 and 2010 in a population consisting of 85 million residents in Guangdong Province. Multistage cluster sampling was adopted to recruit representative samples. The data were obtained through on-site health examinations and face-to-face interviews. RESULTS: The aging trend in this population was not significant (P = 0.17) during the survey period, whereas body mass index/waist circumference increased significantly (P = 0.047 for body mass index and P < 0.001 for waist circumference). The age-standardized prevalence of hypertension increased from 10.5% to 13.3%, averaging a 0.35% increase per year. A higher risk was observed in younger residents over the survey period. Awareness and treatment increased by 22.0% and 19.0%, respectively, in the rural areas, whereas there was no significant change in the urban area (the corresponding figures were 1.8% and -3.1%, respectively). There was no improvement in hypertension control (the age-standardized control prevalence in 2002 was 50.3%, whereas it was 43.2% in 2010). CONCLUSIONS: The prevalence of hypertension increased slightly in this population with the fastest economic development. This increase mirrored the trend of increasing obesity. Awareness and treatment of hypertension have improved in the rural areas, although there were no significant changes in the urban areas. The prevalence of awareness and treatment remains at unacceptably low levels, suggesting that urgent and aggressive strategies are necessary to improve hypertension control and intervention.

Diabetes and pre-diabetes as determined by glycated haemoglobin A1c and glucose levels in a developing southern Chinese population.

BACKGROUND: The American Diabetes Association and World Health Organization have recently adopted the HbA1c measurement as one method of diagnostic criteria for diabetes. The change in diagnostic criteria has important implications for diabetes treatment and prevention. We therefore investigate diabetes using HbA1c and glucose criteria together, and assess the prevalent trend in a developing southern Chinese population with 85 million residents. METHODS: A stratified multistage random sampling method was applied and a representative sample of 3590 residents 18 years of age or above was obtained in 2010. Each participant received a full medical check-up, including measurement of fasting plasma glucose, 2-hour post-load plasma glucose, and HbA1c. Information on history of diagnosis and treatment of diabetes was collected. The prevalence of diabetes obtained from the present survey was compared with the data from the survey in 2002. RESULTS: The prevalence of diabetes based on both glucose and HbA1c measurements was 21.7% (95% CI: 17.4%-26.1%) in 2010, which suggests that more than 1 in 5 adult residents were suffering from diabetes in this developing population. Only 12.9% (95% CI: 8.3%-17.6%) of diabetic residents were aware of their condition. The prevalence of pre-diabetes was 66.3% (95% CI: 62.7%-69.8%). The prevalence of diabetes and pre-diabetes which met all the three diagnostic thresholds (fast plasma glucose, 2 hour post-load plasma glucose, and HbA1c) was 3.1% and 5.2%, respectively. Diabetes and pre-diabetes as determined by HbA1c measurement had higher vascular risk than those determined by glucose levels. The prevalence of diabetes increased from 2.9% (95% CI: 2.0%-3.7%) in 2002 to 13.8% (95% CI: 10.2%-17.3%) in 2010 based on the same glucose criteria. CONCLUSIONS: Our results show that the diabetes epidemic is accelerating in China. The awareness of diabetes is extremely low. The glucose test and HbA1c measurement should be used together to increase detection of diabetes and pre-diabetes.

The prevalence of metabolic syndrome and cardiovascular risk factors in adults in southern China.

BACKGROUND: The metabolic syndrome has been shown to increase the incidence of cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome for southern Chinese. We therefore investigate the prevalence of the metabolic syndrome in a southern Chinese population with 85 million residents. METHODS: The Guangdong Nutrition and Health Survey 2002 is a cross-sectional survey designed to assess the health and nutritional status of 85 million residents in Guangdong province located in southern China. Stratified multistage random sampling method was applied in this survey and a provincial representative sample of 6,468 residents aged 20 years or above was obtained in the present study. The participants received a full medical check-up including measurement of blood pressure, obesity indices, fasting lipids and glucose levels. Data describing socioeconomic and lifestyle factors was also collected through interview. Metabolic syndrome was defined in accordance with the International Diabetes Federation criteria. RESULTS: The prevalence of metabolic syndrome was 7.30%, translating into a total of 4.0 million residents aged 20 years or above having the condition in this southern Chinese population. The urban population had higher prevalence of the syndrome than the rural population (10.57% vs 4.30%). Females had a higher prevalence of metabolic syndrome than males (8.99% vs 5.27%). More than 60% of the adults had at least one component of the metabolic syndrome. CONCLUSIONS: Our results indicate that a large proportion of southern Chinese adults have the metabolic syndrome and associated risk factors. The metabolic syndrome has become an important public health problem in China. These findings emphasize the urgent need to develop population level strategies for the prevention, detection, and treatment of cardiovascular risk in China.

[Association between distorted weight perception and suicide ideation among normal weight adolescents].

OBJECTIVE: To explore the relationship between distorted weight perception and suicide ideation among normal weight adolescents in Guangdong province. METHODS: This study used the data of Guangdong Provincial Youth Health Risk Behavior Survey in 2004 and 2007. To identify the association between distorted weight perception and suicide ideation, a logistic regression analysis was performed. The effects of age, economic status, mother's education, mental health, and depression were also adjusted. RESULTS: A total of 12 729 people participated in this study, 6096 males and 6633 females. The prevalence of suicide ideation among normal weight adolescents was 13.58% (1729/12 729) in the past 12 months, with higher prevalence in girls (16.15%, 1071/6633) than that in boys (10.79%, 658/6096) (χ(2) = 77.71, P = 0.00). It was common that the adolescents misperceived their weight. Only 44.93% (5719/12 729) of normal weight students correctly perceived their body weight while 43.52% (5540/12 729) of them overestimated their weight and 11.43% (1455/12 729) underestimated their weight. The distorted weight perception in girls (65.58%, 4350/6633) was higher than that in boys (43.39%, 2645/6096) (χ(2) = 993.91, P = 0.00). Distorted weight perception was significantly associated with suicide ideation after controlling for factors age, economic status, mother's education, mental health, and depression. The students who overestimate their body weight were more likely to have suicide ideation than that who correctly perceived their weight (OR = 1.43, 95%CI: 1.27 - 1.61). CONCLUSION: The prevalence of distorted weight perception was high and it significantly associated with suicide ideation.

[Prevalence regarding weight misperception and related influencing factors among residents in Guangdong province].

OBJECTIVE: To explore the prevalence of weight misperception and related influencing factors among adult residents in Guangdong province so as to provide information for prevention and control on weight misperception. METHODS: A multi-stage stratified random sampling method was used to select the sample. Forty-two streets/villages were selected from 21 counties/districts through randomly sampling. Four communities were then chosen from every selected town or district, followed by 40 families chosen from every village or community. Questionnaire was used to collect data on weight perception and its related risk factors. SPSS 16.0 was used for data analysis. RESULTS: There were 6625 respondents participating in the study. Out of them, 50.2% participants misperceived their weight status, among which 35.9% of them underestimated while 14.3% overestimated their weights. Females aged 15 - 24 were more likely to overestimate weights than males in the same age group (38.6% vs. 18.5%), while males were more likely to underestimate weights than females (25.8% vs. 8.5%). The prevalence of underestimation on weights increased with the increase of age in both males and females but the prevalence of overestimation on weights decreased. Data from multivariate results from logistic analysis showed that rural residents, males, being elderly, residents with low education level, manual occupations (agriculture, forestry, animal husbandry and fishery), low family income and with anxiety were the major risk factors on underestimation of weight. However, factors as being urban residents, females, adolescents, minority and never having received weight measurement etc. were the major risk factors of overestimated on weight. CONCLUSION: Misperceptions of weight status in Guangdong province exhibited a high prevalence with complicated influencing factors, calling for more psychological research to be carried out to prevent and reduce the misperceptions on weight status.

Relationships between weight status and bullying victimization among school-aged adolescents in Guangdong Province of China.

OBJECTIVE: To examine relationships between weight status and different forms of bullying victimization among adolescents aged 11-18 years. METHODS: The relationships between weight status and bullying victimization (physical, verbal, and relational) were examined utilizing data from the Guangdong Provincial Youth Health Behavior Survey. Data on height, weight, and victimization behaviors were collected by self-reporting from 12 439 subjects. , test and logistic regression were used to analyze relationships between weight and bullying victimization. RESULTS: The incidence of victimization for adolescents aged 11-18 years was 8.6%, with higher rates for boys (12.4%) than for girls (4.7%). For children with normal, overweight and obese body mass index (BMI), the incidence rates of victimization were 8.2%, 17.3%, and 11.5%, respectively. Compared to normal weight, overweight was a risk factor for bullying victimization(OR = 1.60, 95% CI: 1.18-2.17), and it also increased children's risk of being teased in a hurtful way (OR = 2.13, 95% CI: 1.41-3.24) and being made fun of due to physical appearance (OR = 3.58, 95% CI: 2.27-5.67). Obesity only increased the risk for children of being made fun of due to physical appearance (OR = 2.45, 95% CI: 1.44-4.15). CONCLUSIONS: The victimization for children at school is common in Guangdong province, China. Overweight and obese children are more likely to be victims of bullying behaviors, especially verbal victimization.

[Features on suicide attempts and its influencing factors among residents in Guangdong province].

OBJECTIVE: To understand the prevalence of suicide attempts and its related risk factors in Guangdong province to provide scientific basis information for suicide intervention. METHODS: Multi-stage stratified random sampling method was used to select the sample. 42 streets or towns were selected from 21 counties or districts through randomly sampling. 4 communities were then chosen from every selected town or district, followed by 40 families chosen from every village or community. Questionnaire was used to collect data on suicide attempts and its related risk factors. SPSS 16.0 was used for data analysis. RESULTS: 6625 peoples were participated in the study. The 12-month incidence of suicidal attempts was 0.8%. It was higher for females (1.1%) than that for males (0.5%), and the 25 - 35 years (1.6%) age group was among the highest. There was no significant difference between the prevalence rates in urban or rural residents. RESULTS: from multivariate analysis showed that factors as: being female (OR = 2.1), experienced negative events of life (OR = 15.5), in poor sleeping condition (OR = 1.6), feeling lonely (OR = 1.5) and anxiety (OR = 1.8) were high risk for suicide attempts. CONCLUSION: Suicide attempts in Guangdong province exhibited a high prevalence with complicated influencing factors. Comprehensive countermeasures are needed to prevent and reduce suicidal behaviors.

[Evaluation on the health education program regarding prevention of non-fatal drowning among school-aged children in Lianping county, Guangdong province].

OBJECTIVE: To evaluate the outcome of health education program on drowning prevention among primary and secondary school children in rural areas. METHODS: A township was selected and all the students from grade 3 to 5, grade 7 to 8, and grade 10 to 11 were selected to take part in the program. Twelve intervention measures on natural water safety and drowning prevention were carried out for one year. Information was collected using the same questionnaire before and after the intervention program. RESULTS: One year after the intervention was carried out, children's knowledge on drowning prevention improved significantly (13.21, 95%CI: 12.51 - 13.90), and a positive effect was also noticed among boys (12.77, 95%CI: 11.77 - 13.77), girls (13.80, 95%CI: 12.82 - 14.78), and among primary school children(15.51, 95%CI: 14.30 - 16.72), senior high school children (10.78, 95%CI: 9.50 - 12.05) and junior high school children (12.77, 95%CI: 11.84 - 13.71). Overall rates on risk behaviors dropped from 41.4% to 32.2% (by 22.2%) including 15.6% for boys, 35.2% for girls and 13.8%, 29.3%, 26.3% for primary school children, senior high school children, junior high school children, respectively. The incidence rates for non-fatal drowning decreased by 58.9% (from 5.6% to 2.3%). The person-times for treatment on sight, in emergency settings, in outpatient clinic or in the hospitals had a reduction from 399, 78, 36 to 175, 32, 14, respectively. CONCLUSION: Health education program could improve children's perception on water safety, and reduce their risk behaviors as well as on the incidence of non-fatal drowning in the rural areas.

An analysis of risk factors of non-fatal drowning among children in rural areas of Guangdong Province, China: a case-control study.

BACKGROUND: Drowning is a major cause of morbidity and mortality for children, yet non-fatal drowning remains poorly understood. The aim of this study was to explore potential modifiable risk factors of non-fatal drowning among children in rural areas of China. METHODS: A cross-sectional survey was first conducted to obtain non-fatal drowning cases, and 7432 students in grades three to eight from 17 schools participated in the cross sectional survey. Of these, 805 students reported that they experienced non-fatal drowning in the previous year. Then 368 cases were selected randomly to participate in a 1:1 matched case-control study. Each drowning case was matched by one control with the same sex and similar age (the gap less than 2 years) who was selected randomly from the same class. RESULTS: Boys were more likely to be involved in non-fatal drowning. Non-fatal drowning most often happened in the afternoon (65.1%) and natural bodies of water were the most common sites of drowning (71.1%). Swimming, diving and playing in natural waters were the leading activities that preceded non-fatal drowning. The significant risk factors for non-fatal drowning were swimming in natural waters without adult supervision (OR = 3.40, 95% CI: 1.92-6.03), playing in or beside natural waters (OR = 2.08, 95% CI: 1.17-3.70) and poor swimming skills (OR = 2.74, 95% CI: 1.14-6.62). However, the following variables were protective factors: supervisor aged 30 years or over (OR = 0.20, 95% CI: 0.09-0.49) and no water activities (OR = 0.36, 95% CI: 0.18-0.70). CONCLUSIONS: The reduction in dangerous water activities, swimming training and enhancement in supervision among children might decrease the risk of non-fatal drowning.

[Study on health-related behaviors among males in rural and urban residents from Guangdong province].

OBJECTIVE: To compare the magnitude of inequities in health-related behaviors among males in Guangdong province, and to investigate the extent of the disparities. METHODS: Data sets available from the Guangdong Chronic Diseases and Risk Factors Survey 2007 are used. Concentration index (C) and concentration curve are employed to measure the differential of males' health-related behaviors across urban and rural areas in Guangdong. Odds ratios of 6 health-related behaviors among different areas are derived from 4 logistic models, after adjusting for age, married state, educational status, occupation and income. RESULTS: Results from Cs reveal that the inequality gradients disadvantageous to men in rural areas are:smoking (C = -0.075, P = 0.000), alcohol intake (C = -0.023, P = 0.002), blood pressure (C = 0.106, P = 0.000), blood sugar (C = 0.114, P = 0.000) and weight (C = 0.107, P = 0.000), while lack of physical activity (C = 0.044, P = 0.000)concentrates in the more affluent areas. The magnitudes of these inequalities appear to be higher on health-seeking behaviors than on health-risk behaviors. After adjusting for age and marital status, there is still strong evidence showing the rural-urban differences in the health related behaviors among males in Guangdong province. When educational status, occupation and income are added to the logistic model as control factors, the results have led to a loss of statistical significance on such rural-urban inequalities, indicating that socioeconomic factors play an important role on these health-related behaviors which leads to the inequalities among males in Guangdong province. CONCLUSION: To reduce the gaps in health-related behaviors seen in the rural and urban areas, effective policies should be developed to change the social determinants of rural-urban differences in health and to strengthen the implementation of health-related programs on those vulnerable groups.

[Study on the events of nonfatal drowning among primary and middle school students in a rural town of Guangdong province, 2006].

OBJECTIVE: To understand the incidence and characteristics of nonfatal drowning among primary and middle school students in rural area and to provide basic information for intervention. METHODS: A rural town was selected and all students from 3th-8th grades, 10th grade and 11th grade were studied. All data were collected, using a self-administrated questionnaires which was guided by investigator. RESULTS: The overall incidence rate of nonfatal drowning was 5.65% (549/9732) and were 7.69%, 5.80%, 2.39% for primary, secondary and high school students, respectively. Male students had a higher rate (7.14%) than that of females (4.03%). The incidence rates of non-treated, treated in emergency and under hospitalization were 4.52%, 0.77% and 0.35%. The major reasons of drowning were swimming (46.88%), falling into waters (15.67%), diving (13.79%) and rescuing others (6.24%). The proportion of drowning occurred in the afternoon, evening, at noon or in the morning were 59.94%, 15.64%, 14.77% and 9.65% respectively. The common sites of drowning were river/lake (42.48%), swimming pool (19.56%), reservoir (11.39%) and pond (4.38%). 66.76% of the drowning cases were witnessed by other person, and 17.86% were conscious when being removed from waters. CONCLUSION: The incidence of nonfatal drowning among students in rural areas was high, and the natural body of waters was the most common site causing drowning while swimming was the major reason of drowning. Intervention targeting on primary and middle school students in rural should be carried out to reduce the incidence.

[Analysis on pedestrian traffic injury among aged 0-14 years children in Guangzhou, China].

OBJECTIVE: To describe the characteristics of child pedestrian traffic injuries among aged 0-14 years old in Guangzhou city and to provide information on road, vehicle and human injuries in pedestrian. METHODS: A database of all motor vehicle crashes involving child pedestrian traffic injury cases over a five-year period (2000-2004), was from the police department. RESULTS: The annual pedestrian traffic injury rates on incidence, mortality and case fatality were 17.63/ 1,100,000, 1.78/ 100,000 and 10.07% respectively. Both incidence rate and mortality peaked in the 5-9 age group were 26.80/ 100,000 and 2.57/ 100,000, with case fatality peaked in the 0-4 age group (13.29%). For males, the incidence (20.98/ 100,000) and mortality (2.00/ 100,000) were higher than that in females (13.83/ 100,000, and 1.52/ 100,000). The main injured parts of body would include multi-areas (40.34%), head (26.75%) and lower limbs (21.53%). 10.07% of the cases died and 66.18% and 23.75% of them having had severe and slight injures. The major causes were due to drivers (57.50%) and pedestrians (33.47%) faults with top three responsible vehicles were cars (40.14%), two-wheeled motorcycles (34.38%) and vans (22.15%). CONCLUSION: Data from pediatric pedestrian injury poses a threat to children and adolescents, data suggesting that it is important to change behaviors of both drivers and pedestrians.

[A cross sectional survey on serum lipid level and its influencing factors in children aged 3-14 years in Guangdong province].

OBJECTIVE: To investigate the serum levels of cholesterol, triglyceride and high density lipoprotein cholesterol in children aged 3-14 years and its influencing factors. METHODS: The cross-sectional survey study population was a representative sample from Guangdong province obtained by multi-stage randomized cluster sampling. Serum lipids in 6188 children aged > or = 3 years were assayed using automatic biochemical instrument. The data of social and demographic status were collected by face-to-face interview, and height and weight were obtained by physical examination. RESULTS: The age-standardized and region-weighted means of serum total cholesterol (TC), triglyceride (TG), and high density lipoprotein cholesterol (HDL-C) were 0.80 mmol/L, 3.50 mmol/L and 1.28 mmol/L, respectively. For the mean of TG, there was no difference between metropolitan and middle city, nor between rich county and poor county. For TC, it was the highest in metropolitan, and there was no difference between rich and poor county. For HDL-C, the difference existed between every two regions. The age-standardized and region-weighted prevalence of high TG, high TC and low HDL-C were 2.2%, 2.1% and 8.0%, respectively. Metropolitan, rich county, low weight and age between 7.0-9.9 years are protecting factors for high TG, and the number of family between 3-4, age between 7.0-9.9, metropolitan, middle city and poor county are risk factors for high TC. Male, family income per year between 800-9999 RMB, middle city, rich county are protecting factors for low HDL-C. CONCLUSION: The prevalence of abnormal serum lipid was still low compared with other regions in China. The region, number of family member, age and sex may be the important factors influencing on serum lipid levels.

[Study on the epidemiological characteristics of overweight and obesity among population aged eighteen and over in Guangdong Province in 2002].

OBJECTIVE: To describe the epidemiological characteristics of overweight and obesity among people aged 18 and over in Guangdong province in 2002, and to identify the populations and regions under high risk. METHODS: Cross-sectional survey was used through sampling on multi-stage randomized clusters. Data of socialeconomic status were collected by face-to-face interview. Data on weight and height was obtained through physical check-ups. RESULTS: A sample size of 15 130 people and the mean body mass index (BMI) was 22.03 +/- 3.38 with no significant difference between males and females. However the significant difference was seen between cities and rural areas. The crude prevalence rate of overweight and obesity were 16.8% and 1.8%, and the age-adjusted rate were 15.0% and 1.7%, respectively. The crude rate of overweight in cities (24.8%) and males (17.5%) were higher than that in rural areas (9.4%) and females (16.2%). The crude rate of obesity in cities was seen higher than that in the rural areas, but not significantly different between females and males. The results of logistic regression analysis showed that the major risk factors influencing overweight would include household income, age, gender, smoking habits, physical exercises and location of residence. CONCLUSION: About one sixth of the citizens in Guangdong province were considered to be overweighted and obesive had become an important public health problem. Integrated measures must be taken for prevention and control.