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

The commercial residential industry has high added value and comprehensive economic benefit so the commercial residential industry is naturally a hot-spot issue. The core issue of the commercial housing is the price. This thesis conducts the descriptive statistic analysis of residential real estate prices, urban resident income and other relevant data in China’s 30 provinces (excluding Tibet) from 1998 to 2006. The change trend and the difference feature of both the residential real estate price and the urban resident income in those regions are revealed, which is expected to make a contribution to the macro-control in China’s real estate. In recent years, the real estate market in China is growing rapidly. On the one hand, it plays a vital role in both promoting the national economic growth and improving the living standards of urban residents. On the other hand, some problems in the development of China’s current real estate market have been fully exposed, such as the overheated investment, the unbalance in supply and demand, insufficient financing channels, soaring property prices and so on. In particular, the rapid growth in the housing price has brought challenges to the sound development in both China’s real estate market and the whole national economy and it has also become a hot-spot and difficult issue in the current academia. Such relevant research as whether the rapid growth of China’s housing prices has become disjointed with resident income seriously or not and what the rules of the changes in income and housing prices in China’s different regions are is realistically significant for guiding the micro-control in China’s real estate. I. Index Selection and Disposal of Comparability The samples selected in this thesis are composed of the fluctuating residential real estate prices in China’s 30 provinces (excluding Tibet) from 1998 to 2006, urban resident income and other relevant panel data that are from various years of China Statistical Yearbook. The data of the real estate prices adopts the real estate prices in urban areas. The income indexes adopt the annual per capita disposable income of urban residents. In order to remove the impacts of the price and make indexes of various types had comparability in time series, the disposal of comparability has been conducted in indexes of different types in the thesis and their present value has been turned into the value of the constant price, namely, on the basis of the constant price in 1998, the concrete calculation method is that the housing price is deflated by the housing sales price index and the disposable income is deflated by the consumer price index of urban residents. II. Analysis of Commercial Housing Price Variance among Provinces According to the average housing prices and their growth rates in provinces from 1998 to 2006, thirty provinces, cities and autonomous regions across the country can be divided into three types in accordance with the mean and the growth rate of their average housing prices. It’s found that the provinces, cities and autonomous regions of the three types also have common in geographic areas so they can be divided into such three regions as the eastern region, the central region and the western region on the basis of their geographic areas. For the regional division of the average housing price in China, Figure 1 compares the changes in the average housing prices in the central, western and eastern regions from 1998 to 2006. It’s found that the average housing price in the east is prominently higher than those in the western and International Conference on Education Technology, Management and Humanities Science (ETMHS 2015) © 2015. The authors Published by Atlantis Press 1100 central regions and the trend of its average housing prices is on the rise. In particular, the rising trend of the average housing prices is obvious after 2004. The changes in the average housing prices in eastern and western regions are comparatively similar. However, the average prices in the central region are rising slowly while for the western region, a small decline also appears in its slightly rising process. Besides, the average housing prices in the eastern region surpass those in the western region after 2004. III. Analysis of the Differences in the Income Change among Regions Figure 1: Changes in the housing prices in the central, eastern and western regions Figure 2: Changes in the income in the central, eastern and western regions For the regional division of the average housing price in China, Figure 2 compares the changes in the income in the central, western and eastern regions from 1998 to 2006. It’s found that the per capita income in the east is prominently higher than those in the western and central regions and its trend is uniformly on the rise.

Objective: To analyze the prevalence and risk factors of self-reported cancer in adults in China in 2015. Methods: The data used in this study were from China Chronic Disease and Risk Factors Surveillance in 2015. The frequency and proportion of the classified variables were analyzed by descriptive statistics, the disordered classified variables were compared by χ2 test, and the possible risk factors of cancer patients were screened by univariate and multivariate logistic regression analyses. Results: In 2015, there were 1 809 self-reported tumors patients in China, including 689 males (0.63%), 1 120 females (1.03%), 769 (0.71%) in the eastern region, 465 (0.43%) in the central region and 575 (0.53%) in the western region. The patients were mainly distributed in people aged 45- and 55- years old, being overweight or obese, living in eastern urban area, having low education level, being married, having low annual household income and being occupational population. The results of multivariate logistic regression showed that compared with the western region, the prevalence rate of cancer was higher in the eastern region (OR=1.05, 95%CI: 1.04-1.06), while lower in the central region (OR=0.94, 95%CI: 0.93-0.95); the risk for cancer in people with family history of malignancy was higher than that in people without family history of malignancy (OR=1.95, 95%CI:1.94-1.96) the risk for cancer in people with an annual household income of less than 10 000 yuan or between 10 000 and 50 000 yuan was higher than that in people with an annual household income of more than 50 000 yuan (<10 000 yuan: OR=1.59, 95%CI: 1.58-1.60; between 10 000 and 50 000 yuan: OR=1.27, 95%CI: 1.26-1.28); and the risk for cancer in people living urban areas was lower than that in people living in rural areas (OR=0.98, 95%CI: 0.97-0.99). In terms of personal behavior and diet, the risk for cancer in smokers was 1.25 times higher than that in non-smokers (OR=1.25, 95%CI: 1.24-1.26), and the risk for cancer in alcoholics was 1.16 times higher than that in non-alcoholics (OR=1.16, 95%CI: 1.15-1.17), the risk for cancer in people with insufficient vegetable and fruit intakes was 1.29 times and 1.03 times higher than those in people with sufficient intakes of vegetables and fruits, respectively (OR=1.29, 95%CI: 1.28-1.30;OR=1.03,95%CI: 1.02-1.04). People with low frequency of high-intensity exercise had a higher risk for cancer compared with those with high frequency of high-intensity exercise (OR=1.32, 95%CI: 1.31-1.33), the risk for cancer was higher in people with low frequency of moderate exercise than in people with high frequency of moderate exercise (OR=1.08, 95%CI: 1.07-1.09). The risk for cancer in people with sedentary time less than 2 hours was higher than that in those with sedentary time more than 2 hours (OR=1.69, 95%CI: 1.68-1.70), and the risk for cancer in people who ate moderate amount of red meat was lower than that in people who ate excessive amount of red meat (OR=0.86, 95%CI: 0.85-0.87). Conclusions: The number of female self-reported cancer was more than that in males, and the number of self-reported cancer in the eastern region was higher than that in the central and western regions. Living in eastern region, with family history of malignancy, having low annual household income, smoking, drinking, insufficient vegetable intake, insufficient fruit intake and low frequency of high-intensity exercise and low frequency of moderate intensity exercise were the main risk factors for cancer, while living in central region, living in urban area and low red meat intake were protective factors.

To analyze the intakes of main food among the children of 6-17 years in different regions of China from 2019 to 2021, and to provide a scientific basis for evaluation and guiding Chinese children to make reasonable diet. Multistage stratified random sampling method was used to collect data in east China, north China, central China, south China, southwest, northwest and northeast seven areas of each random two provinces, randomly selected from each province one urban survey site and one rural survey site, 28 sites of the 13th Five Year National Science and Technology Basic Resources Survey Project-Chinese children aged 0-18 investigation and application of nutrition and health system in 14 provinces of China. The study included 6413 children aged 6 to 17. Three consecutive 24-hour recalls method combined with weighing were used to collect the information of food intake. According to the food classification in the standard version of the food composition list, the food was divided into cereals, tubers, fresh vegetables, fresh fruits, meat and poultry, fish and shrimp, eggs, milk, etc. , and the intake of various foods was calculated for boys and girls aged 6-8, 9-11, 12-14 and 15-17 in different regions. Compared with the average daily food intake of children of the same sex and age in the urban and rural, The average daily intake of cereals and tubers for boys aged 9-17, cereals for girls aged 9-17, tubers for girls aged 12-17, and fish and shrimp for boys of edible population aged 15-17 were higher in rural areas than in urban areas. There were differences in the average daily food intake and consumption rate of fresh vegetables, fresh fruits, meat and poultry, eggs and milk of the same sex and age, which were higher in urban than in rural areas(P&lt;0.05). Compared with the average daily food intake of children of the same sex and age in the south and the north, the average daily intake of cereals and eggs for boys aged 9-14, cereals for girls aged 6-8, and fresh fruits for boys and girls of edible population aged 6-17 were higher in the north than in the south. There were differences in average daily intake and consumption rates of tubers, fresh vegetables, meat and poultry, milk and fish and shrimp of the same sex and age, which were higher in the south than in the north(P&lt;0.05). Compared with the average daily food intake of children of the same sex and age in the eastern, central and western regions, the average daily intake of cereals for boys aged 6-14, cereals for girls aged 6-17, fresh fruits for boys and girls of edible population aged 6-17, and fish and shrimp for boys and girls of edible population aged 15-17 were lower in the eastern region than in the central and western regions. The average daily intake of tubers for boys aged 9-11 and 15-17, for girls aged 9-17 were higher in the western regions than the eastern and central regions. The average daily intake of eggs for boys and girls aged 12-17 was lower in western regions than the eastern and central regions. There were differences in average daily intake and consumption rates of fresh vegetables, meat and poultry and milk of the same sex and age, which were higher in the eastern region than in the central and western regions. (P&lt;0.05). The proportion of coarse grains to cereals was low, between 3.7% and 10.1%. The proportion of pork to meat and poultry was high, between 56.1% and 71.4%. In China, there are differences in daily intake of main food for children aged 6 to 17 years old in urban and rural areas, north and south areas, east, central and west areas.

This research measures the green economic efficiency (GEE) of 30 regions in China from 2009 to 2021 and verifies the financial agglomeration and environmental regulation impacts on GEE with the Tobit model. The conclusions are as follows: (1) The average GEE value in China is 0.596—which is still at a low level—and is highest in the eastern region and lowest in the western region. (2) Financial agglomeration can promote GEE in the whole country, in both the eastern and western regions; however, the western region effect is very low. In the central region, due to the “siphon effect” produced by the eastern region, the financial resources concentrated in the east thus suppress GEE. Environmental regulation inhibits GEE nationally and in the western region while showing a promotion effect in the eastern and central regions, but it is not significant in the central region. (3) Industrial structures inhibit GEE nationally and in the central and western regions, while industrial structures promote GEE in the eastern region; the GDP (gross domestic product) per capita also inhibits GEE nationally and in the central and western regions and promotes GEE in the eastern region. Government intervention inhibits green economic development in all regions, and urbanization inhibits GEE nationally and in the central and western regions while promoting GEE in the eastern region.

Urbanization-induced urban diseases threaten public health. The World Health Organization launched the Healthy City Initiative in 1986, and China has incorporated it into the Healthy China 2030 strategy. Currently, China faces significant regional development disparities, and issues regarding the development level of the healthy city in China, as well as its spatiotemporal pattern and convergence, remain to be clarified to promote the equalization of health services. Using panel data of Chinese cities from 2011 to 2022, this study constructs an evaluation system covering 4 dimensions and 25 indicators, and applies the entropy weight method to measure the development level of China's healthy city development. Methods including exploratory spatial data analysis, spatial correlation analysis, trend surface analysis, kernel density analysis, Dagum Gini coefficient, and kernel density estimation are used to reveal the spatiotemporal pattern of China's healthy city development. The β-convergence model is employed to conduct the convergence test. From 2011 to 2022, the average level of healthy city development increases from 0.149 to 0.269, representing a growth rate of 80.5%. At the regional level, it exhibits a gradient differentiation characteristic described as "the eastern region taking the lead, while the central and western regions showing similar levels below the national average". Spatially, it presents a pattern of "low levels in inland hinterlands and high levels in coastal and border areas". The global Moran's I index ranges from 0.129 to 0.152 (P < 0.001). The Gini coefficient fluctuates downward from 0.172 to 0.123, with the contribution rate of inter-regional disparities falling within the range of 55% to 60%. The kernel density distribution curves of all regions shift continuously to the right, with the main peak widening first and then narrowing; the degree of internal differentiation in the eastern region is higher than that in the central and western regions. Significant absolute β convergence and conditional β convergence are observed both at the national level and across the three major regions. In terms of convergence speed, the western region has the fastest convergence rate (1.37%) with a half-life of approximately 51years, the central region has a convergence rate of 1.34% with a half-life of 52years, and the eastern region has a relatively slower convergence rate (1.00%) with a half-life of 69years. Regarding the convergence-driving factors, economic development and government intervention in the eastern region, urbanization in the central region, and financial development in the western region promote convergence, while opening-up in the western region inhibits convergence. Healthy city development in China shows an overall steady upward trend, but significant regional gradient disparities exist, forming a spatial pattern characterized by high-value agglomerations in coastal and border areas and contiguous low-value clusters in inland hinterlands. Regional disparities generally demonstrate a narrowing trend, with inter-regional disparities being the primary source of overall disparities; the degree of internal differentiation within the eastern region is higher than that of the central and western regions. Convergence exists at both the national level as well as across the eastern, central, and western regions. The eastern region should strengthen economic support and government intervention, the central region should promote the balanced development of healthy cities through urbanization, and the western region should increase financial support and reasonably guide opening-up, so as to drive the convergence of healthy city development. The modular framework constructed in this study, which consists of the evaluation index system, spatiotemporal pattern analysis, and convergence test, features strong universality. Moreover, the research findings can provide scientific guidance for the coordinated development of healthy cities in China and offer a Chinese practical reference for global healthy city construction.

This paper adopts the super-efficient DEA (data envelopment analysis) model to measure the forestry eco-efficiency (FECO) of 30 Chinese provinces and cities from 2008 to 2021, and then introduces the Tobit model to explore the influencing factors of FECO to better understand the sustainable development level of forestry. It draws the following conclusions: (1) The average value of FECO in China is 0.504, which is still at a low level, and the FECO of each region has significant regional heterogeneity; the provinces with higher FECO are mainly concentrated in the eastern region, while the FECO of the central and western regions is lower; (2) In terms of the main factors affecting FECO in China, the regression coefficients of market-based environmental regulations are significantly positive in the national, eastern and central regions, while they are significantly negative in the western region. The coefficient of impact of scientific research funding investment on forestry industry eco-efficiency is negative and shows a significant promotion effect in the eastern region, but the elasticity coefficient in the central and western regions is negative but not significant. Economic development has a positive but insignificant effect on FECO, with the eastern region showing a positive correlation, while the central and western regions are insignificant. Industrial structure has a significant negative effect on FECO in the national, eastern and central regions, but the effect of industrial structure on FECO in the western region is not significant. The effect of foreign direct investment on FECO was negative for the national, central and western regions, but the central region did not pass the significance test, while the eastern region reflected a significant promotion effect.

Based on the cost-benefit data (1980–2002) of farm products and China Agriculture Yearbooks, this paper studies the regional disparity in the changes of the agricultural land use in China during the period 1980–2002 from three aspects such as the degree of intensity, the sown area and the abandoned farmland. The results show that: (1) The degree of intensity of land use in the western region during 1980–2000 has a strong uptrend, but in the eastern and central regions the degree of intensity descends obviously and has shown a continuous downtrend since 1997. (2) The total sown area shrinks notably in the eastern region, while it enlarges constantly in the western region. (3) The sown area in the eastern, central and western regions has gone through a similar cyclic process: down (1980–1985)-up (1985–1991)-down (1991–1994)-up (1994–1999)-down (1999–2002). However, there are obvious differences in amplitude variation and tendency among them. The sown area has shrunk in the eastern region and expanded in the central and western regions especially before 1999. (4) The most cases of abandoned farmland are reported in the central region, the second in the eastern region and the least in the western region. The abandonment phenomena chiefly occurred during 1992–1995 in the eastern region, and during 1998–2002 in the central region.

Asymmetric influence of digital finance, and renewable energy technology innovation on green growth in China

How land transfer marketization influence on green total factor productivity from the approach of industrial structure? Evidence from China

Promoting green development and promoting harmonious coexistence between humans and nature are strategic tasks for the construction of ecological civilization in China in the new era. Currently, the growing environmental governance investment in China has not performed well, and the low efficiency of environmental governance has become the main problem facing the development of ecological civilization in China. Therefore, it is of great practical significance to scientifically measure the efficiency of environmental governance and improve the efficiency of environmental governance input factors to achieve green development and overcome the difficulties in the construction of ecological civilization. In this study, an improved three-stage SBM model and cloud model combined with the Theory of production, life, and ecology were used to measure the environmental governance efficiency of 27 provinces in China from 2003 to 2020 and conduct in-depth analysis and evaluation. The results show that: First, the influence of random error factors and external environmental conditions on the efficiency of rural domestic sewage treatment in China is significant. Their existence will underestimate the environmental governance efficiency in the central and western regions of China and overestimate the environmental governance efficiency in the eastern regions of China, except for Hainan Province. Second, after excluding the influence of random errors and external environment conditions, the adjusted efficiency mean value of the central and western regions significantly increases, while the environmental governance efficiency of most provinces in the eastern region, except for Hainan Province, decreases significantly. Third, the overall environmental governance efficiency of the 27 provinces in China still presents a situation wherein the western region is ranked first in efficiency, the eastern region ranks second, and the central region ranks third. The environmental governance efficiency of the 27 provinces shows a “large at both ends, small in the middle” and “low efficiency in the eastern and central regions, and instability in the western region” state, and there is a large difference in the degree of environmental governance efficiency among the various provinces. In this regard, for the eastern and central regions, special attention should be paid to their government’s transformation of development thinking, placing greater emphasis on balanced and coordinated development between urbanization, industrialization, and the environment. As for the western region, due to its harsh environmental conditions, it attaches more importance to environmental governance. However, efforts should be made to strengthen its economic development to ensure sufficient provision of material conditions such as infrastructure and equipment required for environmental governance in order to achieve stable environmental governance efficiency in the western region. For the central region, both the economy and the environment need to be further strengthened.

Extreme precipitation events induced by tropical cyclones have increased frequency and intensity, significantly impacting human socioeconomic activities and ecological environments. This study systematically examines the spatiotemporal characteristics of these events across Hainan Island and their influencing factors using GsMAP satellite precipitation data and tropical cyclone track data. The results indicate that while the frequency of typhoon events in Hainan decreased by 0.3 events decade−1 from 1949 to 2020, extreme precipitation events have increased significantly since 2000, especially in the eastern and central regions. Different typhoon tracks have distinct impacts on the island, with Track 1 (Northeastern track) and Track 2 (Central track) primarily affecting the western and central regions and Track 3 (Southern track) impacting the western region. The impact of typhoon precipitation on extreme events increased over time, being the greatest in the eastern region, followed by the central and western regions. Incorporating typhoon precipitation data shortened the recurrence interval of extreme precipitation in the central and eastern regions. Diurnal peaks occur in the early morning and late evening, primarily affecting coastal areas. Typhoon duration (CC_max = 0.850) and wind speed (CC_max = 0.369) positively correlated with extreme precipitation, while the pressure was negatively correlated. High sea surface temperature areas were closely associated with extreme precipitation events. The atmospheric circulation indices showed a significant negative correlation with extreme precipitation, particularly in the western and central regions. ENSO events, especially sea surface temperature changes in the Niño 1 + 2 region (−0.340 to −0.406), have significantly influenced typhoon precipitation characteristics. These findings can inform region-specific disaster prevention and mitigation strategies for Hainan Island.

Objective: To estimate the effect of high total cholesterol (TC) on life expectancy in China. Methods: Population attributable fractions (PAF) of high TC were calculated in both urban, rural areas and regions, using data related to TC levels from the chronic disease risk factor surveillance in China, 2013. Together with PAFs, data related to death registry, demographics, attributable deaths from high TC and its effect on life expectancy, were estimated. Results: In 2013, the TC level in Chinese population aged 25 and above appeared as (4.8±1.0) mmol/L, higher in urban areas[(4.8±1.0) mmol/L]than that in rural areas[(4.7±1.0) mmol/L)], with the highest in eastern regions[(4.9±1.0) mmol/L] and lowest in the central regions [(4.6±1.0) mmol/L]. TC level appeared as (4.8±1.0) mmol/L in both sexes. A total of 2.9% of all the deaths were attributed to high TC (264 998 deaths), among which 89.3% were caused by ischemic heart disease (236 540 deaths). PAF was seen higher in females (3.7%) than that in males (2.3%), higher in urban (3.4%) than that in rural areas (2.4%), with the highest in eastern (3.7%) and lowest in western regions (2.1%). Mortality that attributed to high TC was 19.6/100 000, higher in females (21.2/100 000) than that in males (18.0/100 000), higher in urban(20.8/100 000) than that in rural areas (18.2/100 000), with the highest in eastern (23.2/100 000) and lowest in western regions (15.6/100 000). In 2013, the loss of life expectancy that caused by high TC was 0.30 year, higher in females (0.35 year) than in males (0.26 year), higher in urban (0.34 year) than that in rural areas (0.28 year), with the highest seen in the eastern (0.36 year) and lowest (0.23 year) in the western regions. Conclusion: In 2013, the effect of high TC on life expectancy appeared different between genders, urban and rural areas or regions, with greater impact on females, urban and eastern areas of the country.

Objective: To analyze the change in human resources within China's Centers for Disease Control and Prevention (CDC) from 2010 to 2020. Methods: The self-reported information from provincial, prefectural (city), and county (district) levels of China's CDC, covering employee counts, staff composition, professional qualifications, educational backgrounds, technical titles, and tenure, were extracted from the China Disease Prevention and Control Information System. The demographic context was provided by the annual population figures from the China Statistical Yearbook (2010-2020). The profile of CDC personnel was described, and the average annual percentage rate change (AAPC), average annual percentage rate change (APC), human resource agglomeration degree (HRAD) and the difference between HRAD and population agglomeration degree (PAD) were calculated. The Joinpoint regression model was used to analyze the time trend. Results: The decade under review witnessed a net increase of 17 300 active and 18 300 enrolled personnel in the CDC, surpassing the national population growth rate with AAPCs of 0.93% and 1.03%, respectively. This upward trajectory was statistically significant (P<0.05). The ratio of disease control personnel per 10 000 population escalated from 1.14 to 1.21. An initial decline in active CDC workforce density (from 1.31 to 1.27 per 10 000 population between 2010 and 2017) was followed by an increase (from 1.28 to 1.37 between 2018 and 2020), with APCs of -0.40% and 3.73%, respectively. The proportion of professional and technical staff in 2019 was highest in the eastern region (86.01%), followed by the western (83.75%) and central regions (79.54%). The period also saw an enhancement in the average academic degree (from 1.91 to 2.43 points) and professional title scores (from 1.39 to 1.53 points) of CDC personnel. While the average tenure in the eastern and western regions showed a slight decline, the central region experienced an increase, with HRAD values indicating a higher concentration in the eastern and central regions compared to the western region. The HRAD-PAD discrepancy revealed a negative value in the eastern region, nearing zero in the central and western regions. Conclusion: Between 2010 and 2020, China's CDC experienced notable growth in human resources and underwent structural optimization, albeit with significant regional disparities in concentration.

Objective: The epidemiological characteristics of tuberculosis deaths among Chinese residents from 2006 to 2021 were analyzed, and the tuberculosis mortality rate from 2022 to 2027 was predicted to provide a reference for tuberculosis prevention and control in China. Methods: The data set of tuberculosis deaths from 2006 to 2021 was published regularly by the China CDC, and the crude mortality rate (CMR) and age-standardized mortality rates (ASMR) were calculated according to the population structure of China in 2000. The distribution characteristics of age, sex, region, and time of tuberculosis deaths were analyzed, the Joinpoint regression analysis model was used to analyze the changing trend, and the grey model was applied to predict CMR and ASMR from 2022 to 2027. Results: From 2006 to 2021, the CMR and ASMR of tuberculosis showed a downward trend among males and females, urban and rural areas, and all age groups, in a word, all the Chinese residents. Except for the age group ≥85 years old, the mortality trend was insignificant. In the eastern, central, or western regions. CMR and ASMR were significantly higher in males than in females.CMR and ASMR were significantly lower in urban areas than in rural areas. In general, active tuberculosis patients present a higher mortality rate. The CMR and ASMR in the western region were higher than those in the eastern and central regions and lower in the eastern region than in the central region, but the differences were less obvious. The ASMR of the eastern cities was lower than that of the central and western regions, and the ASMR of the central cities was higher than that of the western region from 2006 to 2009 and 2012 and lower than that of the western region in other years. The ASMR in the western countryside was higher than that in the eastern and central regions and lower in the eastern part than in the central region, but the difference was not obvious. The grey model prediction results show that the CMR (/100 000) of Chinese residents from 2022 to 2027 is 1.585, 1.471, 1.360, 1.250, 1.143, and 1.038, and the ASMR (/100 000) is 0.779, 0.653, 0.531, 0.411, 0.295 and 0.181, respectively. Conclusions: The CMR and ASMR of tuberculosis will continue to decline, and extraordinary achievements have been made in tuberculosis prevention and control in Chinese residents from 2006 to 2021 and, presumably, from 2022 to 2027. However, tuberculosis screening and treatment programs in the western region, men, the elderly population, and rural areas should be further strengthened, and targeted prevention and control measures should be formulated to reduce mortality.

BackgroundThe Chinese government offered various types of training programs for strengthening the role of doctors working in community health service institutions (CHSIs). The study intended to investigate the current training programs and training needs of doctors nationally in urban CHSIs in China, and to provide propositions for training more qualified doctors in the future.MethodsTotal 3098 doctors in 192 urban CHSIs were chosen from 9 provinces (Hebei, Liaoning, Shandong, Zhejiang, Fujian, Hunan, Guangxi, Guizhou, Ningxia) and one municipality (Beijing) among 31 provinces in eastern, central, and western regions by stratified sampling methods in Mainland China. All doctors in the selected CHSIs were investigated in this study. We discharged 3073 questionnaires, and the response rate was 98.0%. Descriptive statistics were used to describe the characteristics, training contents, problems and needs of doctors. Differences in training contents, problems and needs between eastern, central and western regions were analyzed with chi-square tests.Results49.3% of doctors in CHSIs had Bachelor’s degree and beyond. 12.9% of doctors had senior professional titles. The most frequent training topics for the doctors in eastern, central and western regions were “basic clinical theory knowledge” (52.4%), “community health service competency” (59.6%), “clinical practice skills” (45.9%) respectively. The most serious problem for doctors was “insufficient training time” in eastern (36.8%), central (36.5%) and western (39.6%). The biggest knowledge need for doctors both in eastern (79.8%) and central region (79.1%) was “the updated international medical knowledge”, in western region it was “the updated domestic medical knowledge” (73.2%). The biggest skill-related training need for doctors in eastern region (84.1%) and central region (82.6%) was “communication skills”, and “diagnosis and differential diagnosis” in western region (78.2%).ConclusionGovernment should design proper training contents according to the knowledge and skill needs of different design. Furthermore, a uniform, rigorous training and evaluation system focus on practicability should be established to promote community health service system in Mainland China.