Death In Urban Areas Research Articles

Estimates of global mortality burden associated with short-term exposure to fine particulate matter (PM2·5)

The acute health effects of short-term (hours to days) exposure to fine particulate matter (PM2·5) have been well documented; however, the global mortality burden attributable to this exposure has not been estimated. We aimed to estimate the global, regional, and urban mortality burden associated with short-term exposure to PM2·5 and the spatiotemporal variations in this burden from 2000 to 2019. We combined estimated global daily PM2·5 concentrations, annual population counts, country-level mortality rates, and epidemiologically derived exposure-response functions to estimate the mortality attributable to short-term PM2·5 exposure from 2000 to 2019, in the continental regions and in 13 189 urban centres worldwide at a spatial resolution of 0·1° × 0·1°. We tested the robustness of our mortality estimates with different theoretical minimum risk exposure levels, lag effects, and exposure-response functions. Approximately 1 million (95% CI 690 000-1·3 million) premature deaths per year from 2000 to 2019 were attributable to short-term PM2·5 exposure, representing 2·08% (1·41-2·75) of total global deaths or 17 (11-22) premature deaths per 100 000 population. Annually, 0·23 million (0·15 million-0·30 million) deaths attributable to short-term PM2·5 exposure were in urban areas, constituting 22·74% of the total global deaths attributable to this cause and accounting for 2·30% (1·56-3·05) of total global deaths in urban areas. The sensitivity analyses showed that our worldwide estimates of mortality attributed to short-term PM2·5 exposure were robust. Short-term exposure to PM2·5 contributes a substantial global mortality burden, particularly in Asia and Africa, as well as in global urban areas. Our results highlight the importance of mitigation strategies to reduce short-term exposure to air pollution and its adverse effects on human health. Australian Research Council and the Australian National Health and Medical Research Council.

Analysis of News Media-Reported Snakebite Envenoming in Nepal during 2010-2022.

Snakebite envenoming is a well-known medical emergency in the Terai of Nepal in particular. However, there is an epidemiological knowledge gap. The news media data available online provide substantial information on envenomings. Assessing this information can be a pristine approach for understanding snakebite epidemiology and conducting knowledge-based interventions. We firstly analyzed news media-reported quantitative information on conditions under which bites occur, treatment-seeking behavior of victims, and outcomes of snakebite envenomings in Nepal. We analyzed 308 Nepalese snakebite envenomed cases reported in 199 news media articles published between 2010 and 2022 using descriptive statistics, Wilcoxon, and Chi-square tests to know why and how victims were bitten, their treatment-seeking behavior, and the outcomes. These envenomated cases known with substantial information represented 48 districts (mostly located in the Terai region) of Nepal. These envenomings mostly occurred in residential areas affecting children. Generally, envenomings among males and females were not significantly different. But, in residential areas, females were more envenomed than males. Further, victims' extremities were often exposed to venomous snakebites while their active status and these episodes often occurred at night while victims were passive during snakebites indoors and immediate surroundings of houses. Snakebite deaths were less among referred than non-referred cases, males than females, and while active than passive conditions of victims. The most of reported envenomed patients were children, and most envenomings were due to cobra bites. Consultation with traditional healers complicated snakebite management. In most cases, deaths that occur without medical interventions are a severe snakebite consequence in Nepal. Further, several deaths in urban areas and mountains and higher hills of Nepal suggest immediate need of snakebite management interventions in the most affected districts. Therefore, there is an urgent need to immediately admit Nepalese snakebite victims to nearby snakebite treatment centers without adopting non-recommended prehospital interventions. The strategies for preventing snakebite and controlling venom effects should also include hilly and mountain districts where snakebite-associated deaths are reported.

Exploring Intergenerational Linguistic Identity of Dhatki Speakers in Sindh, Pakistan

Pakistan is a multilingual country where seventy four languages are spoken (Siddiqui, 2019). English is the official language, while Urdu is used as a common Lingua Franca; while each province has its own provincial official language (Sindhi, Punjabi, Pashto & Balochi). The language policy of Pakistan promotes dominant languages only; as a result indigenous languages are becoming extinct and gradually are on the verge of language shift and death in urban areas. Hence, maintaining a linguistic identity in such a context pose serious challenges to the speakers of a language. This paper explores the linguistic identity of Dhatki language speakers across three generations in the different districts of Sindh. For this purpose, a qualitative case study was conducted and data was collected using open-ended questionnaire and the responses were analyzed thematically. Data was collected using purposive and snowball sampling from 33 participants. The results highlighted that Dhatki language was going through a gradual language loss, its speakers stigmatized the use of the language due to lack of documentation, and the constant use of dominant languages in different spheres of social and educational life. The speakers attributed this shift to governmental negligence and language activist’s behavior towards Dhatki language

Changing Patterns in Cancer Mortality from 1987 to 2020 in China.

China has the highest number of new cancer cases and deaths worldwide, posing huge health and economic burdens to society and affected families. This study comprehensively analyzed secular trends of national cancer mortality statistics to inform future prevention and intervention programs in China. The annual estimate of overall cancer mortality and its major subtypes were derived from the National Health Commission (NHC). Joinpoint analysis was used to detect changes in trends, and we used age-period-cohort modeling to estimate cohort and period effects in Cancers between 1987 and 2020. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks were calculated. The age-standardized cancer mortality in urban China has shown a steady downward trend but has not decreased significantly in rural areas. Almost all cancer deaths in urban areas have shown a downward trend, except for colorectal cancer in men. Decreasing mortality from cancers in rural of the stomach, esophagus, liver, leukemia, and nasopharynx was observed, while lung, colorectal cancer female breast, and cervical cancer mortality increased. Birth cohort risks peaked in the cohorts born around 1920-1930 and tended to decline in successive cohorts for most cancers except for leukemia, lung cancer in rural, and breast and cervical cancer in females, whose relative risks were rising in the very recent cohorts. In addition, mortality rates for almost all types of cancer in older Chinese show an upward trend. Although the age-standardized overall cancer mortality rate has declined, and the urban-rural gap narrowed, the absolute cancer cases kept increasing due to the growing elderly population in China. The rising mortality related to lung, colorectal, female breast, and cervical cancer should receive higher priority in managing cancer burden and calls for targeted public health actions to reverse the trend.

Trends in temperature-mortality projections across urban and rural regions under different climate change scenarios in Switzerland

Temperature vulnerability tends to be heterogenous between urban and rural regions, with usually larger risks in the former. However, it is unclear whether this pattern will persist under different climate change scenarios. Climate change combined with population growth, ageing and urbanization is expected to amplify the current temperature-related mortality burden, particularly since these drivers will follow diverse trajectories across urban and rural areas in the future. This study aimed to compare the impact of climate change regarding changes in heat- and cold-related mortality under various warming scenarios across urban/rural districts in Switzerland, while also accounting for changes in population demographics. We first estimated the district-age-specific (<75/>=75years) temperature-mortality association between 1990-2010 in Switzerland using a two-stage time series design with distributed-lag nonlinear models. We then projected heat- and cold-related mortality under 1.5C, 2.0C, 3.0C and 4.0C warming scenarios using downscaled temperature projections under RCP8.5 while accounting for the Shared Socio-economic pathway (SSP5) population development storyline. In Switzerland, heat- and cold-related mortality will increase by 2,420(95%CI:1654;3,884) and 993(82;1883) deaths /year, respectively, under 4.0C warming (vs. 1990-2010). Urban areas are more affected by both heat and cold and this pattern appears to be amplified under warmer scenarios. In particular, per 100 heat-related deaths in rural areas, there will be an increase from 362 to 391 deaths in urban areas, with similar results for cold (from 262 to 286 per 100 deaths in rural areas), indicating a slight increase in vulnerability to climate change in urban regions in the near future. Our preliminary findings suggest that climate change will increase current heat and cold-related mortality in Switzerland, and moreover, urban areas will continuously more be disproportionately affected. Further analyses will aim to account for urbanization projections and disentangle the contribution of the different drivers across urban and rural regions.

The incidence and mortality of endometrial cancer in China, 2015

Objective: To estimate endometrial cancer (EC) incidence and mortality in China in 2015. Methods: Qualified cancer registry data collected in 2011-2015 were pooled for analysis, from which EC cases and deaths were extracted. EC cases were classified into endometrioid, nonendometrioid and other & unspecified according to their histologic types. Incidence and mortality rates stratified by region and age group were calculated. Population data of 2015 was used to estimate cancer cases and deaths in China. Segi's population was used for the calculation of age-standardized rates by world standard population (ASW). Results: Data from 158, 176, 239, 235, 231 qualified cancer registries of 2011 to 2015 were pooled together. These registries covered about 488 million population, including about 255 million population in urban area and 233 million population in rural area. In 2015, a total of 53 600 EC cases were estimated, with a crude incidence rate of 7.74/100 000 and an ASW of 5.13/100 000. Incidence rates were higher in urban areas (9.15/100 000) than in rural areas (6.20/100 000). A total of 10 700 deaths were estimated, with a crude mortality rate of 1.60/100 000 and an ASW of 0.98/100 000. Mortality rate was higher in urban areas (1.78/100 000) than in rural areas (1.40/100 000). Among reported EC cases during 2011-2015, 70.92% (23 641 cases) were endometrioid, 5.13% (1 709 cases) were nonendometrioid and 23.95% (7 982 cases) were other & unspecified. The mean age at onset of all EC cases was 55.9±10.6. The mean age at onset of endometrioid cases (55.7±10.0) was younger than that of nonendometrioid cases (57.7±10.8) (P<0.001). The mean age at onset of all histologic types in urban areas was higher than that in rural areas (P<0.001). The mean age at death for EC deaths was 63.9±12.5. The mean age at death in urban areas (65.3±12.5) was higher than that in rural areas (61.4±12.2) (P<0.001). Conclusion: EC disease burden differs between urban and rural areas. Targeted cancer prevention and control strategies should be made for each region.

Mitigating China’s Ozone Pollution with More Balanced Health Benefits

China is confronting the challenge of opposite health benefits (OHBs) during ambient ozone (O3) mitigation because the same reduction scheme might yield opposite impacts on O3 levels and associated public health across different regions. Here, we used a combination of chemical transport modeling, health benefit assessments, and machine learning to capture such OHBs and optimize O3 mitigation pathways based on 121 control scenarios. We revealed that, for the China mainland, Beijing-Tianjin-Hebei and its surroundings ("2 + 26" cities), Yangtze River Delta, and Pearl River Delta, there could be at most 2897, 920, 1247, and 896 additional O3-related deaths in urban areas, respectively, accompanying 21,512, 3442, 5614, and 642 avoided O3-related deaths in rural areas, respectively, at the same control stage. Additionally, potential disbenefits during O3 mitigation were "pro-wealthy", that is, residents in developed regions are more likely to afford additional health risks. In order to avoid OHBs during O3 abatement, we proposed a two-phase control strategy, whereby the reduction ratio of NOX (nitrogen oxide) to VOCs (volatile organic compounds) was adjusted according to health benefit distribution patterns. Our study provided novel insights into China's O3 attainment and references for other countries facing the dual challenges of environmental pollution and associated inequality issues.

Carotid Artery Segmentation Using Convolutional Neural Network in Ultrasound Images

Cardiovascular disease (CVD) is one of the leading causes of death in urban areas. Carotid artery segmentation is the initial step in the automated diagnosis of carotid artery disease. The segmentation of carotid wall and lumen region boundaries are used as an essential part in assessing plaque morphology. In this paper, two types of Convolutional Neural Network (CNN) architectures are used for segmentation: U-Net and SegNet. The models used in this paper are applied on 257 ultrasound images containing a transverse section of the vessel acquired by ultrasound. Ultrasound imaging is noninvasive, completely unharming for the patient and a low-cost imaging method, but the main challenge when working with this kind of images is a very low signal to noise ratio and the process of imaging is highly dependent on the device operator. Different models are tested for various ranges of hyperparameter values and compared using different metrics. The model presented in this paper achieved over 94% Dice Coefficient for wall and lumen segmentation when trained during 100 epochs.

Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities

BackgroundDying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010–2015, and to assess if such inequalities are related to palliative or non-palliative conditions.MethodsThis is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables.ResultsWe analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected.ConclusionsThe probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.

Health impacts of long-term ozone exposure in China over 2013–2017

Increasing ozone concentrations are becoming a severe problem for air pollution in China and have an adverse impact on human health. Here we evaluate premature deaths attributable to long-term exposure to ambient ozone in China between 2013 and 2017 with an air quality model at 5 km resolution and the latest estimates of the relative risk to health. We use a modified inverse distance weighting method to bias-correct the key model-simulated ozone metrics. We find that on a 5-year average basis there are 186,000 (95% Confidence Interval: 129,000–237,000) respiratory deaths and 125,000 (42,000–204,000) cardiovascular deaths attributable to ozone exposure. Sichuan exhibits the largest per capita respiratory mortality (0.31‰) among all provinces. We find that there are 73,000 (51,000–93,000) premature respiratory deaths in urban areas, accounting for 39% of total deaths. Between 2013 and 2017 the population-weighted annual average maximum daily 8-h average ozone (AMDA8) and premature respiratory deaths increased by 14% and 31%, respectively, at a national level. Changes in precursor emissions explain most of these increases, with differences in meteorology accounting for 21% and 16% respectively. Interannual variations in population-weighted ozone and premature respiratory deaths at a provincial level are much larger than those at a national level, particularly in northern, central and eastern China. These findings emphasize that ozone should be an important focus of future air quality policies in China, and tighter controls of precursor emissions are urgently needed.

DID EARLY TWENTIETH‐CENTURY ALCOHOL PROHIBITION AFFECT MORTALITY?

We investigate the contemporaneous mortality consequences of alcohol prohibition laws introduced in America between 1900 and 1920. We improve on existing studies by constructing a time‐varying measure of prohibition at the state level that corrects for the timing of prohibition enforcement and accounts for the presence of dry counties. Using summary indices that aggregate alcohol‐related mortality due to disease and poor decisions, we find that prohibition significantly reduced mortality rates. These findings are corroborated with an area‐level analysis that exploits data on deaths in urban areas that were wet prior to statewide or federal prohibition and nonurban areas that were partially dry. (JEL I18, N4, K2)

Did Early Twentieth Century Alcohol Prohibition Matter?

We investigate the contemporaneous mortality consequences of alcohol prohibition laws introduced in America between 1900 and 1920. We improve on existing studies by constructing a time-varying measure of prohibition at the state-level that corrects for the timing of prohibition enforcement and accounts for the presence of dry counties. Using summary indices that aggregate alcohol-related mortality due to disease and poor decisions, we find that prohibition significantly reduced mortality rates. These findings are corroborated with an area-level analysis that exploits data on deaths in urban areas that were wet prior to statewide or federal prohibition and non-urban areas that were partially dry.

Annona Muricata L Leaf Infusion Effect on Glucose Absorption in the Intestinal Cells Membrane of Wistar Rats Model

Background : Diabetes mellitus (DM) is a chronic disease that disrupts the homeostasis of glucose. DM is the second of most causes of deaths in urban areas, as well as the sixth in rural areas. Therefore, herbal medicine is constantly developed. Soursop leaves have been long known to have good effects in lowering glucose levels in our blood. This study explored the soursop leaves infusion on glucose absorption in the intestinal cell membrane of the Wistar Rats Model. Methods : This was an exploratory study performed in October 2012 on five male rats Wistar, aged 3-4 months, weighing about 150-300 grams. Using the in situ perfusion method, each rat was given the following; 3 X 10-3 M glucose solution for one hour; 3 X 10-3 M glucose solution with 1 mL of infusion of soursop leaves (Annona muricata L) for one hour; 3 X 10-3 M glucose solution for the last hour. The glucose absorption levels were measured using spectrophotometry method. The glucose level between treatments was analyzed using a paired sample t-test. Results : The concentration of glucose absorption was decreased, the first treatment was 24.42+14.29 mg/dL, the second treatment was 18.63+10.37 mg/dL, and the third treatment was 18.24+8.02mg/dL), however, the decrease of glucose absorption was statistically not significant. Conclusions : There is a slightly decreased of the glucose absorption in the intestinal cell membranes of the Wistar Rats Model after infusion of soursop leaves. Further study is needed to explore the role of soursop leaves infusion in glucose absorption.

Relationship Strategy Family Coping With Quality Of Life In Elderly Post Stroke

Background: Stroke is the highest cause of death in urban areas, one of the regions in Indonesia with stroke exceeds the national rate is the city of Pontianak.&#x0D; Purpose : This study aims to determine the relationship of family coping strategies to the quality of life of elderly post-stroke in the city of Pontianak.&#x0D; Methods : Analytical research design correlation with cross sectional approach. sampling in total sampling with respondents amounted to 58 respondents. The sample of this study was post-stroke elderly and family members as caregiver or primary outpatient who treated elderly with post stroke.&#x0D; Result : The results of multiple linear regression analysis or anova test (f test) with p value = 0.001 (&lt;0.05) indicating that there is a significant relationship between social support, reframing, seeking and receiving, passive income and income with the quality of life of the elderly post stroke.&#x0D; Conclusion : Social support is a dominant element of coping strategy. The role of community nurses is needed to support family caregivers in providing social support to post-stroke elderly.

Temperature Variability and Mortality in Urban and Rural China: An Application of Spatiotemporal Index

Temperature variability (TV) is a potential trigger for death in urban areas, but there is little evidence of this in rural areas. In addition, a typical TV index only considers the temporal change...

Temperature variability and mortality in rural and urban areas in Zhejiang province, China: An application of a spatiotemporal index

BackgroundTemperature variability (TV) is a potential trigger for death in urban areas, but there is little evidence of this in rural areas. In addition, a typical TV index only considers the temporal variability of temperature and ignores its spatial variability, which should be considered due to the effects of human mobility. Here this study aimed to 1) develop a novel spatiotemporal TV index accounting for human mobility; and 2) based on this index, explore the urban–rural differences in TV–mortality associations in China. MethodsWe collected daily data on fine-gridded hourly temperatures and >2 million deaths that occurred in Zhejiang province, China from 2009 to 2015. A spatiotemporal TV index was developed by calculating the standard deviation of the hourly temperatures from multi-site records over the course of several exposure days. A three-stage analysis was performed to estimate the mortality risks and mortality burdens of TV. Stratified analyses were performed by cause-specific mortality, urban/rural district, age and gender. ResultsSignificant associations were found between TV and all types of targeted diseases, age groups, and genders. Percentage increase in mortality associated with a 1 °C increase in TV at 0–7 exposure days were found to be higher for rural dwellers than urban dwellers in the warm season [for all-cause mortality, 2.07% (95% CI: 1.49%, 2.64%) vs. 1.16% (95%CI: 0.70%, 1.62%)]. An estimated all-cause mortality fraction of 5.33% was attributable to TV, with 4.99% in urban areas and 6.02% in rural areas. The elderly (aged 65+ years) and females were more sensitive to TV than young people and males, respectively. ConclusionsA spatiotemporal TV index was developed, considering both the temporal and spatial variability of temperatures. TV is an independent health risk factor. In China, rural areas generally suffer greater TV-related mortality risks than urban areas in the warm season. Our findings have important implications for developing area-, cause-, and group-specific adaptation strategies and emergency planning to reduce TV-related mortality.

Point process methods in epidemiology: application to the analysis of human immunodeficiency virus/acquired immunodeficiency syndrome mortality in urban areas.

The analysis of spatio-temporal patterns of disease or death in urban areas has been developed mainly from the ecological studies approach. These designs may have some limitations like the ecological fallacy and instability with few cases. The objective of this study was to apply the point process methodology, as a complement to that of aggregated data, to study HIV/AIDS mortality in men in the city of Alicante (Spain). A case-control study in residents in the city during the period 2004-2011 was designed. Cases were men who died from HIV/AIDS and controls represented the general population, matched by age to cases. The risk surfaces of death over the city were estimated using the log-risk function of intensities, and we contrasted their temporal variations over the two periods. High risk significant areas of death by HIV/AIDS, which coincide with the most deprived areas in the city, were detected. Significant spatial change of the areas at risk between the periods studied was not detected. The point process methodology is a useful tool to analyse the patterns of death by HIV/AIDS in urban areas.

Retrospective analysis of population-based causes of death and life expectancy in urban Western China from 2003 to 2012.

BackgroundHitherto, a population-based analysis of the cause of death in urban areas of Western China has not been undertaken over an extended period. The aims of this study were to calculate the overall and annual cause-specific mortality rates by age and sex in urban areas of Western China from 2003 to 2012 and to evaluate the quality of the data.MethodsWe used Excel software, cause-of-death registrations, and International Classification of Diseases, 10th revision, codes to calculate the overall and yearly cause-specific crude mortality rates by age and sex, the Chinese age-standardized mortality rate, and life expectancies.ResultsIn the Jiulongpo District from 2003 to 2012, there was an increase in the number of death case reports in the census-registered population, a decrease in the number of omitted deaths, and rise in the crude mortality rate. Except for 2003, the Chinese age-standardized mortality rate was the lowest in 2012 (330.83/100,000) and highest in 2005 (390.08/100,000). Life expectancy increased from 78.36 years in 2005 to 81.67 years in 2012.ConclusionsWith the development of its social economy, the Chinese government and public attach greater importance to cause-of-death surveillance. The quality of cause-of-death registrations has gradually increased, crude mortality rates have risen, the Chinese age-standardized mortality rate has fallen, and life expectancies have increased.

The epidemiological transition of first-ever stroke among low-income population in China: a population-based study from 1992 to 2014

BackgroundStroke is the leading cause of death in rural areas and the third cause of death in urban areas in China, but the epidemiological transition of stroke during periods of rapid economic development is unknown in China, especially in rural areas. We aimed to investigate the secular trends in incidence, prevalence, and the 30-day case fatality of first-ever stroke in rural China between 1992 and 2014. MethodsWe assessed the secular trends in the epidemiological transition of stroke in Tianjin, China. The study population was from the Tianjin Brain Study, a population-based stroke surveillance study among low-income residents in a township in Tianjin, China, where stroke events and all deaths have been registered annually from 1992 to 2014. We used data from the Tianjin Brain Study to estimate case-fatality rates, the age-standardised incidence and prevalence of first-ever stroke per 100 000 population with the world standardisation population. Trends in age-standardised incidence and prevalence of stroke were assessed from annual percentage of change by sex and subtypes using the regression model: log(rt)=a+bt, where log denotes the natural logarithm and t is the year, and 100b represents the estimated annual percentage of change. FindingsBetween 1992 and 2014, the age-standardised incidence of first-ever stroke per 100 000 population increased annually by 6·3% overall, by 5·5% in men, and by 7·8% in women (p<0·0001); the case fatality decreased annually by 3·9% overall (p=0·024) and by 6·0% in women (p=0·015), but did not change in men (p=0·072). Simultaneously, the age-standardised prevalence of first-ever stroke per 100 000 population increased annually by 10·6% overall, by 9·9% in men, and by 11·5% in women (p<0·0001). With respect to stroke subtypes, the age-standardised incidence of first-ever stroke from intracerebral haemorrhage increased annually by 4·6% overall (p=0·022), by 3·5% in men (p=0·009), and by 4·8% in women (p=0·016), whereas the incidence of ischaemic stroke increased annually by 7·2% overall, by 6·6% in men, and by 8·3% in women (p<0·0001). The corresponding prevalence of intracerebral haemorrhage increased annually by 8·0% overall, 7·0% in men, and 9·9% in women, whereas the prevalence of ischaemic stroke increased annually by 11·4% overall, by 10·9% in men, and by 12·4% in women. InterpretationThe epidemiological transition of stroke was found among a low-income population in China. The incidence and prevalence of stroke from intracerebral haemorrhage and ischaemic stroke increased rapidly in both men and women. These findings suggest that it is crucial to prevent stroke among low-income population in China to reduce the burden of disease worldwide. FundingThe Ministry of Science and Technology of the People's Republic of China and National Key Project of Clinical Neurology, Tianjin Medical University General Hospital.

Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996–2007

BackgroundWhile research continues into indicators such as preventable and amenable mortality in order to evaluate quality, access, and equity in the healthcare, it is also necessary to continue identifying the areas of greatest risk owing to these causes of death in urban areas of large cities, where a large part of the population is concentrated, in order to carry out specific actions and reduce inequalities in mortality. This study describes inequalities in amenable mortality in relation to socioeconomic status in small urban areas, and analyses their evolution over the course of the periods 1996–99, 2000–2003 and 2004–2007 in three major cities in the Spanish Mediterranean coast (Alicante, Castellón, and Valencia).MethodsAll deaths attributed to amenable causes were analysed among non-institutionalised residents in the three cities studied over the course of the study periods. Census tracts for the cities were grouped into 3 socioeconomic status levels, from higher to lower levels of deprivation, using 5 indicators obtained from the 2001 Spanish Population Census. For each city, the relative risks of death were estimated between socioeconomic status levels using Poisson’s Regression models, adjusted for age and study period, and distinguishing between genders.ResultsAmenable mortality contributes significantly to general mortality (around 10%, higher among men), having decreased over time in the three cities studied for men and women. In the three cities studied, with a high degree of consistency, it has been seen that the risks of mortality are greater in areas of higher deprivation, and that these excesses have not significantly modified over time.ConclusionsAlthough amenable mortality decreases over the time period studied, the socioeconomic inequalities observed are maintained in the three cities. Areas have been identified that display excesses in amenable mortality, potentially attributable to differences in the healthcare system, associated with areas of greater deprivation. Action must be taken in these areas of greater inequality in order to reduce the health inequalities detected. The causes behind socioeconomic inequalities in amenable mortality must be studied in depth.