Hepatitis C: a continuing public health challenge in China

BackgroundIn China, the HIV prevalence continues to rise despite increasing efforts to contain the epidemic, and other sexually transmitted infections (STIs) are also on the increase. Furthermore, antibiotic-resistant STI pathogens...

We describe the emergence of recent public health challenges in China, particularly those regarding lifestyle-related non-communicable diseases (NCDs). We also summarize some recent examples of behavioral medicine research and practice in relation to the prevention and control of NCDs in China. Finally, we describe recent changes in the public health system in China and how behavioral medicine research and practice can be incorporated into this system to address these public health challenges. We considered research and policy literature from both China and Western countries in order to evaluate the relevance of the field of behavioral medicine for addressing the rising NCDs in China. Rapid economic development and related social and environmental changes have brought about increasing wealth and lifestyle changes in China, along with new public health challenges related to the prevention and control of NCDs. The field of behavioral medicine has much to offer China in addressing these public health challenges. Although behavioral medicine research and practice are still at an early stage in China, there are encouraging signs of its development, particularly resulting from international collaborations with researchers from Western countries. The next stage of this field's development in China will involve increased integration of behavioral medicine into public health education, training, and the health system. However, this process of integration will need to build on China's traditional approaches to public health training, research, and practice. Although the field of behavioral medicine in public health is still in its infancy in China, we argue that the practice and principles of behavioral medicine are important for successfully addressing the substantial burden of NCDs now and in the future.

In the twenty-first century, with the rapid social economic development, the process of industrialization, urbanization, and population aging has led to the changes of disease pattern, ecologic environment, and lifestyle. China is now facing a complex situation with health threats from multiple diseases and various health determinants, which are the similar difficult issues that both the developed and developing countries have to deal with. Specifically, the challenges in China cover the following perspectives: demographic changes, double burden of diseases due to changes of disease spectrum, the negative effects of industrialization and urbanization, food and drug safety issues, public health emergencies, and health inequities [1].

Sporotrichosis, a fungal infection caused by Sporothrix species, can greatly lead to chronic inflammation of the skin, mucosa, and lymphatic vessels and disseminate systemically sometimes, even threatening life. It is known that Sporothrix is distributed worldwide, while in China, most of the cases were reported in northeast China and parts of south China. Sporothrix globosa is the main source of infection, and other regions may lack relevant awareness and attention to the disease, making it a public health challenge in China. Thus, it is important to understand its epidemiology and public health risks to prevent and control the disease properly.

Human immunodeficiency virus (HIV)/AIDS among elderly persons presents a new public health challenge in China. We aimed to explore historical trends (2004-2018) and project the future (2019-2030) burden of HIV/AIDS incidence and mortality among the elderly in China. We utilized data from the Data Center of China Public Health Science database on HIV/AIDS incidence and mortality, employing the Bayesian age-period-cohort model to reveal the age-period-cohort effect in the HIV/AIDS burden, and projecting the incidence and mortality rates up to 2030. From 2004 to 2018, HIV/AIDS incidence rates increased from 0.56 to 20.78 per 100 000 for men and 0.28 to 7.84 per 100 000 for women. The mortality rates also increased in both sexes. We observed the highest age effect in incidence among men aged 70-74 years and women aged 55-59 years, with the effect estimates being 0.02 (95% confidence interval [CI], -.10 to .13) and 0.46 (95% CI, .35-.57), respectively. Similar sex disparities were observed for mortality, with the highest age effect observed in men aged 75-79 years and women aged 50-54 years. However, no significant disparities were found between men and women in the period and cohort effects. By 2030, the incidence rates were projected to be 96.25 per 100 000 in men and 44.90 per 100 000 in women, while the mortality rates were projected to be 48.27 and 13.67 per 100 000, respectively. HIV/AIDS incidence and mortality rates rose notably among the elderly in China and are expected to keep increasing in the coming decades. Rates were consistently higher in men than in women. Tailored interventions for older men are crucial.

BackgroundNon-rheumatic calcific aortic valve disease (NRCAVD) has emerged as a significant health challenge globally, with China’s rapidly aging population bearing a disproportionate burden, necessitating comprehensive epidemiological analysis to guide public health strategies.MethodsUtilizing data from the Global Burden of Disease (GBD) database 2021, we examined the incidence, prevalence, mortality, and disability-adjusted life years (DALYs), along with their corresponding age-standardized rates (ASRs), of NRCAVD in China from 1990 to 2021 and compared these data with global trends. The analysis employed joinpoint regression to calculate the estimated annual percentage change (EAPC) and average annual percentage change (AAPC) for evaluating NRCAVD trends over the past 32 years. Additionally, we employed the Bayesian age–period–cohort model to project these trends through 2050.ResultsThe age-standardized incidence and prevalence rates of NRCAVD in China increased from 1.42 to 2.52 per 100,000 and 17.24 to 32.68 per 100,000, respectively, between 1990 and 2021. Favorably, the age-standardized mortality and disability-adjusted life year rates of NRCAVD decreased from 0.10 to 0.07 per 100,000 and 2.42 to 1.92 per 100,000, respectively. The rates were higher in male individuals than in female individuals across all four metrics over the study period. In China, the estimated annual percentage changes for incidence, prevalence, mortality, and disability-adjusted life years were 2.04, 2.33, −1.34%, and −1.06%, respectively, while the average annual percentage changes for incidence, prevalence, mortality, and disability-adjusted life years were 0.04, 0.50, 0.00%, and −0.02%, respectively. The projections from Bayesian age–period–cohort model showed that the burden of NRCAVD is expected to continue through 2050.ConclusionThe burden of NRCAVD in China has dramatically increased from 1990 to 2021, with a notable rise associated with aging. Male individuals appear to be more susceptible than female individuals and face higher mortality risks associated with NRCAVD in China. The forecast suggests that this trend will persist until 2050, highlighting NRCAVD as a significant public health challenge in China over the next three decades.

Background With the rapid growth of the elderly population and public health challenges in China, concerns arise related to disability associated with activities of daily living (ADLs) and alcohol consumption status. This study assesses the relationships of alcohol consumption status with basic daily activities among Chinese older adults. Methods A total of 5,133 participants aged 60 years or above from three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014) were analyzed. Independent ADL items included bathing, dressing, toileting, indoor moving, continence, and feeding (without others’ assistance). Multilevel ordered logistic regression model estimation was used to examine the results of total scores based on the Katz index. Multilevel logistic regression models also were estimated to study each index item separately to examine differences across each of the six ADLs. Additional confirmatory factor analysis (CFA) was performed to examine the validity of the index. Results Preliminary CFA showed that most items had good factor loadings (>0.700), except for continence (0.256) and feeding (0.481). Based on the ordered regression model, former (AOR = 0.412, 95% CI: 0.294, 0.579, p < 0.001) and non-alcohol consumption (AOR = 0.598, 95% CI: 0.447, 0.800, p < 0.001) were negatively associated with the total score. Non-alcohol consumption status was negatively associated with ADL items separately (all ps < 0.05), with the exceptions of continence and feeding. Conclusion Alcohol consumption may be associated with Chinese older adults’ better ADLs. However, further clinical or experimental trials are needed to examine the impact of alcohol consumption on older adults’ ADLs.

Metabolic dysfunction-associated steatohepatitis (MASH)-induced liver cancer (MALC) is a global public health challenge. This study aims to analyze the epidemiological characteristics of MALC from 1990 to 2021 and project future trends up to 2050 in China. Data on MALC were obtained from the Global Burden of Disease Study (GBD) 2021, including incidence, deaths, and disability-adjusted life-years (DALYs). The burden of MALC in China and trends in age-standardized rate (ASR) were analyzed using estimated annual percentage changes (EAPCs). Additionally, the attributable risk factors for MALC-related deaths and DALYs in China were assessed, and Bayesian age-period-cohort models were used to predict trends in ASR up to 2050. Compared to 1990, the number of MALC incidence, deaths, and DALYs in China more than doubled by 2021. From 1990 to 2021, the age-standardized incidence rate (ASIR) [EAPC: 0.72; 95% confidence interval (CI) 0.52 to 0.92] and age-standardized mortality rate (ASMR) (EAPC: 0.33; 95% CI 0.13 to 0.53) of MALC showed an upward trend. The ASIR, ASMR, and age-standardized DALYs rate (ASDR) in males consistently exceeded those in females. In 2021, the burden of MALC incidence, deaths, and DALYs in China was predominantly concentrated in the 65–69 age group. Among the risk factors recorded in GBD 2021, age-standardized MALC mortality in China in 2021 was primarily attributable to high fasting plasma glucose and smoking. It was also found that the proportion of risk factors for MALC in China was similar to those in high-middle SDI regions and World Bank upper-middle-income regions. Furthermore, predictive models estimate that by 2050, the ASIR and ASMR of MALC in both male and female patients in China will show a declining trend. The burden of MALC in China exhibits age and gender disparities. Although its future burden is expected to improve, it remains a significant public health challenge in China. Targeted intervention strategies must be developed based on its epidemiological characteristics and risk factors to mitigate the burden of MALC in China.

PM2.5 pollution remains a critical environmental and public health challenge in China despite post-2015 improvements. However, our understanding of the spatially heterogeneous and nonlinear associations of its driving factors remains limited. To fill this gap, we employ an explainable geospatial artificial intelligence (GeoAI) framework that integrates the geographical random forest (GRF) model and the Shapley additive explanations (SHAP) approach to examine the associations between 16 determinants and PM2.5 concentrations. Based on a nationwide and multi-year analysis across 288 cities selected from all 336 Chinese cities between 2015 and 2022, the results show that GRF achieves at least a 0.04 higher R² than baseline models. Our analysis reveals three findings. First, population density is the most influential factor in 52.39% of cities; combined with temperature, road density, and gas supply, these four dominate over 95% of cities. Second, drivers exhibit significant spatially varying and nonlinear associations. For instance, population density correlates positively with PM2.5 in the North China Plain but negatively in sparsely populated areas; and the association of temperature follows an inverted U-shaped pattern. Third, these spatial and nonlinear associations undergo temporal changes. These findings offer insights for future environmental management strategies to mitigate the negative impacts of various drivers.

BackgroundFew nationally representative surveys regarding body composition and metabolic syndrome (MetS) have been done in a large-scale representative Chinese population to explore the prediction of body composition indicators for MetS. The objective of this study was to examine the relation of body composition and MetS and to determine the optimal cut-off values of body composition indicators that predict MetS in a large representative Chinese sample based on multiple provinces and ethnicities, covering a broad age range from 10 to 80 years old.MethodsThe subjects came from a large-scale population survey on Chinese physiological constants and health conditions conducted in six provinces. 32,036 subjects completed all blood biochemical testing and body composition measure. Subjects meeting at least 3 of the following 5 criteria qualify as having MetS: elevated blood pressure, lower high density lipoprotein cholesterol level, higher triglyceride level, higher fasting glucose level and abdominal obesity.ResultsThe total prevalence rate of MetS for males (9.29%) was lower than for females (11.58%). The prevalence rates were 12.03% for male adults and 15.57% for female adults respectively. The risk of MetS increased 44.6% (OR = 1.446, 95%CI: 1.414–1.521) for males and 53.4% (OR = 1.534, 95%CI: 1.472–1.598) for females with each 5% increase of percentage of body fat. The risk of MetS increased two-fold (OR = 2.020, 95%CI: 1.920–2.125 for males; OR = 2.047, 95%CI: 1.954–2.144 for females respectively) with each 5% increase of waist-hip ratio. The risk of MetS increased three-fold (OR = 2.915, 95%CI: 2.742–3.099 for males; OR = 2.950, 95%CI: 2.784–3.127 for females respectively) with each 5% increase of Waist-to-Height Ratio (WHtR). Areas under the receiver operating curve (AUC) of most body composition indicators were larger than 0.70 and the sensitivities and the specificities of most cut-off values were larger than 0.65. AUCs of WHR and WHtR were the largest. The optimal cut-off values of WHtR were 0.51 for males and 0.53 for females.ConclusionMetS has become a serious public health challenge in China. Body composition variables were closely related to MetS and they were reliable indicators in the screening of the presence of MetS.

Due to the increasing number of returnees from malaria endemic areas, imported malaria has become a public health challenge in China. To better understand the characteristics of imported Plasmodium species and adjust appropriate strategies for malaria prevention and control in Eastern China, we conducted molecular detection and species identification on 1282 imported malaria cases in Shandong Province between 2012 and 2018. The findings showed that P. falciparum was predominant, particularly in cases imported from Africa. P. vivax was the dominant species imported from Asian countries. Additionally, imported P. ovale and P. malariae emerged in the province. Further surveillance and control of imported malaria among returnees from Africa and Southeast Asia is needed to be strengthened in Eastern China.

Hookworm infection, a neglected tropical disease (NTD) causing iron-deficiency anaemia and malnutrition in low-income populations with poor sanitation, poses a considerable public health challenge in China and worldwide. National surveillance across 31 provincial-level administrative divisions (PLADs) from 2016 to 2021 assessed regional and population-specific hookworm prevalence. Geospatial methods, such as global and local autocorrelation, hotspot detection, spatiotemporal clustering detection and standard deviation ellipse (SDE) analysis characterized distribution patterns. Machine learning identified key determinants and their associations with infection rates, revealing primary influence factors based on 7,929 township records and 40 environmental, climatic and anthropogenic variables. Significant geographic disparities emerged, with the highest infection rates in south-western regions and the lowest in the Northeast. Spatial analyses demonstrated significant clustering, with persistent south-western hotspots and north-eastern coldspots (P < 0.001). Spatiotemporal scanning identified three significant clusters, while SDE analysis indicated stable northeast-southwest orientation with minimal centroid variation. Females and individuals ≥60 years showed elevated susceptibility. Machine learning demonstrated strong predictive capacity, with key risk factors identified as the frequency of barefoot farming, land cover, average relative humidity in the third quarter and average monthly sunshine duration in the third quarter. Hookworm disease clusters in south-western China, disproportionately affecting women and the elderly. Barefoot farming emerged as the primary risk factor, with infection rates positively associated with temperature, humidity and negatively with sunlight duration. The results support recommendations to target intervention zones in endemic areas, implement population-specific prevention programs and intensify health education to advance transmission control.

BackgroundSyphilis remains one of the serious public health challenges in China and worldwide. This study aims to assess the potential independent risks associated with age, period, and birth cohort for the reported incidence of syphilis in Eastern China.MethodsData on all syphilis cases from 2005 to 2024 in Zhejiang Province in Eastern China were collected from the China Information System for Disease Control and Prevention. The Age-Period-Cohort (APC) model was used to analyze the effect coefficients, which were then converted into relative risks (RRs).ResultsFrom 2005 to 2024, a total of 617,097 syphilis cases were reported in Zhejiang Province. The reported incidence of syphilis decreased by an average of −3.53% per year across all age groups (95% CI: −4.34, −2.70%). The age effect showed that the highest reported incidence was among individuals aged 20–24 years, with a relatively high rate also observed in those aged 60 years and above. The period effect indicated that compared with the reference group of 2010–2014 with the highest reported incidence risk, the risk in 2020–2024 was the lowest (RR = 0.48; 95% CI: 0.43, 0.54). The cohort effect shows that the risk decreased in later birth cohorts, with the highest reported incidence risk in the birth cohort of 1960–1964 (RR = 1.30; 95% CI: 1.08, 1.57) and the lowest risk in the birth cohort of 2020–2024 (RR = 0.00; 95% CI: 0.00, 0.18).ConclusionThe reported incidence of syphilis in Zhejiang Province has shown an overall downward trend. The implementation of national syphilis control programs has achieved significant results. There is a need to strengthen the management of late-stage syphilis among older adults and enhance syphilis prevention and control efforts among adolescents.

Projected cardiovascular mortality attributable to extreme temperatures under climate scenarios in Taiyuan, China.

A satellite-driven model to estimate long-term particulate sulfate levels and attributable mortality burden in China