Disease Surveillance Points Research Articles

GW24-e2330 Impact of Cardiovascular Disease Deaths on Life Expectancy in the Chinese Population

ObjectivesWe aimed to analyse the impact of cardiovascular disease (CVD) deaths on life expectancy (LE) in the Chinese population. We also aimed to estimate the percentage reduction in CVD mortality...

Bicyclist mortality between 2006 and 2010 in China: findings from national Disease Surveillance Points (DSP) data

ContextWhile road traffic mortality has been reported to be seriously undercounted by the police in China, non–police-reported data have not been explored previously to examine vulnerable road user mortality.ObjectiveTo examine...

Suicide rates in Shandong, China, 1991–2010: Rapid decrease in rural rates and steady increase in male–female ratio

BackgroundChina has one of the highest suicide rates in the world; however, the recent trends in suicide have not been adequately studied. This study aimed to examine the potential changes in the rates and characteristics in a Chinese population. MethodsData on suicide deaths in 1991–2010 were extracted from the Shandong Disease Surveillance Point (DSP) mortality dataset based on ICD-10 codes. The temporal trend in age-adjusted suicide rates for each subpopulation was tested using log-linear Poisson regression analysis. ResultsFrom 1991 to 2010, there was a marked decrease in the overall suicide rate in Shandong, with an average reduction of 8% per year. The decrease trend was stronger in rural than in urban areas and more evident in females than in males. Similar decreases were observed for all age groups. Pesticide ingestion and hanging remained the top two methods for suicide. LimitationsThere are likely quality concerns in the morality data, such as underreporting and misclassification, as well as low accuracy in determining the underlying causes of deaths. The representativeness of the DSP system may also be problematic due to the rapid changes in economy and demography. ConclusionsCompleted suicides in Shandong have sharply declined over the past 20 years. Higher rates in females versus males and in rural versus urban areas, which were previously considered to be distinguishing features of suicide in China, are becoming less pronounced.

THE TREND AND VARIATION OF CARDIOVASCULAR DISEASE MORTALITY FROM YEAR OF 2004 TO 2010 IN CHINA

Objectivesto report the epidemic status, trend and variation of cardiovascular disease (CVD) mortality from year of 2004 to 2010 in China.MethodsThe mortality data album of population-based survey, 2004 and 2008...

Current status of diabetes, hypertension and dyslipidemia among older Chinese adults in 2010

To investigate the distribution of hypertension, diabetes and dyslipidemia among elderly population in China in 2010. In 2010, The 3rd Chronic Non-communicable Disease & Risk Factor Surveillance in China was conducted in 31 provinces and Xinjiang Production & Construction Corps. A stratified multi-stage cluster sampling was used from 162 National Disease Surveillance Points (DSPs). A total of 19 981 residents aged ≥ 60 years received a set of standardized questionnaire interview, physical examinations and laboratory test for lipid & glucose levels in blood. After complex weighting of the sample, the prevalence of hypertension, diabetes and dyslipidemia were compared for different gender, age groups and regions. After complex weighting, among elderly, the overall prevalence of hypertension was 66.9%, and the rates were greater in the eastern areas (67.9%) than in the western areas (62.5%) (P < 0.05), there was no significant difference between urban areas and rural areas (P > 0.05); the prevalence of diabetes was 19.6%, the rates were greater in the eastern areas (21.5%) than in the western areas (17.7%) (P < 0.05), and greater in the urban areas (25.0%) than in the rural areas (17.0%) (P < 0.05) ; the prevalence of high triglycerides, high blood cholesterol and high low-density lipoprotein were all higher in the urban areas (12.4%, 6.4% and 5.2%) than in the rural areas (10.1%, 4.2% and 2.8%) (all P values < 0.05), and also higher for women (12.9%, 6.9% and 4.7%) than for men (8.7%, 2.9% and 2.4%) (all P values < 0.05); the prevalence of hypertension in people with abnormal blood lipids (74.3%) was higher than those with normal blood lipids (65.7%) (P < 0.05); the prevalence of hypertension and dyslipidemia in people with diabetes (77.3%, 23.2%) were both greater than the prevalence in non-diabetic group (64.5%, 12.6%) (both P values < 0.05). The present study showed high prevalence of hypertension, diabetes and dyslipidemia among elderly people in China. The rates were greater in the eastern than in the western and higher for women than for men. The rates of diabetes and dyslipidemia were significantly higher in the urban areas than in the rural areas. Comprehensive prevention and control of hypertension, diabetes and dyslipidemia among the elderly should be enhanced.

The under-report adjustment of injury deaths data from National disease surveillance points system of China

BackgroundThe National Disease Surveillance Points System (DSPs) of China was established in 1980, and currently consists of 161 nationally representative urban and rural sites from 31 provinces covering 78 million...

PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS IN CHINA: FINDINGS FROM 2010 CHINA CHRONIC DISEASE AND RISK FACTOR SURVEILLANCE

PREVALENCE OF CARDIOVASCULAR DISEASE RISK FACTORS IN CHINA: FINDINGS FROM 2010 CHINA CHRONIC DISEASE AND RISK FACTOR SURVEILLANCE

The gap in injury mortality rates between urban and rural residents of Hubei province, China

BackgroundInjury is a growing public health concern in China. Injury death rates are often higher in rural areas than in urban areas in general. The objective of this study is to compare the injury mortality rates in urban and rural residents in Hubei Province in central China by age, sex and mechanism of injury.MethodsUsing data from the Disease Surveillance Points (DSP) system maintained by the Hubei Province Centers for Disease Control and Prevention (CDC) from 2006 to 2008, injury deaths were classified according to the International Classification of Disease-10th Revision (ICD-10). Crude and age-adjusted annual mortality rates were calculated for rural and urban residents of Hubei Province.ResultsThe crude and age-adjusted injury death rates were significantly higher for rural residents than for urban residents (crude rate ratio 1.9, 95% confidence interval 1.8-2.0; adjusted rate ratio 2.4, 95% confidence interval 2.3-2.4). The age-adjusted injury death rate for males was 81.6/100,000 in rural areas compared with 37.0/100 000 in urban areas; for females, the respective rates were 57.9/100,000 and 22.4/100 000. Death rates for suicide (32.4 per 100 000 vs 3.9 per 100 000), traffic-related injuries (15.8 per 100 000 vs 9.5 per 100 000), drowning (6.9 per 100 000 vs 2.3 per 100 000) and crushing injuries (2.0 per 100 000 vs 0.7 per 100 000) were significantly higher in rural areas. Overall injury death rates were much higher in persons over 65 years, with significantly higher rates in rural residents compared with urban residents for suicide (279.8 per 100 000 vs 10.7 per 100 000), traffic-related injuries, and drownings in this age group. Death rates for falls, poisoning, and suffocation were similar in the two geographic groups.ConclusionsRates of suicide, traffic-related injury deaths and drownings are demonstrably higher in rural compared with urban locations and should be targeted for injury prevention activity. There is a need for injury prevention policies targeted at elderly residents, especially with regard to suicide prevention in rural areas in Central China.

Seasonality of suicide in Shandong China, 1991–2009: Associations with gender, age, area and methods of suicide

Whether suicide in China has significant seasonal variations is unclear. The aim of this study is to examine the seasonality of suicide in Shandong China and to assess the associations of suicide seasonality with gender, residence, age and methods of suicide. Three types of tests (Chi-square, Edwards' T and Roger's Log method) were used to detect the seasonality of the suicide data extracted from the official mortality data of Shandong Disease Surveillance Point (DSP) system. Peak/low ratios (PLRs) and 95% confidence intervals (CIs) were calculated to indicate the magnitude of seasonality. A statistically significant seasonality with a single peak in suicide rates in spring and early summer, and a dip in winter was observed, which remained relatively consistent over years. Regardless of gender, suicide seasonality was more pronounced in rural areas, younger age groups and for non-violent methods, in particular, self-poisoning by pesticide. There are statistically significant seasonal variations of completed suicide for both men and women in Shandong, China. Differences exist between residence (urban/rural), age groups and suicide methods. Results appear to support a sociological explanation of suicide seasonality.

Distribution and Hepatocellular Carcinoma–Related Viral Properties of Hepatitis B Virus Genotypes in Mainland China: A Community-Based Study

Hepatitis B virus (HBV) genotypes, replication status, and mutations have been associated with the risk of hepatocellular carcinoma (HCC). Our aim was to study the distribution and HCC-related viral properties of HBV genotypes/subgenotypes in Mainland China. A multistage cluster probability sampling method was applied to select 81,775 participants between 1 and 59 years at 160 national disease surveillance points. We examined hepatitis B surface antigen, HBV genotypes and subgenotypes, hepatitis B e antigen, viral load, and mutations in the PreS and core promoter regions of HBV genome. HBV subgenotypes B2 (27.3%), C1 (10.7%), and C2 (58.0%) were predominant. Genotype D (D1, 80.8%) was frequent in the Uygur. We identified a new subgenotype, C9, mainly in Tibetans. Compositions of subgenotypes B2 and C1 and genotype mixture increased from the North to Central South, which was consistently associated with the increasing prevalence of hepatitis B surface antigen. Hepatitis B e antigen positivity and viral loads were higher in the young with genotype B and declined more rapidly with increasing age than those with genotype C. In contrast to G1896A, PreS deletion, T31C, T1753V, and A1762T/G1764A were more frequent in subgenotype C2 than in subgenotype B2. A1762T/G1764A, T1753V, C1653T, and G1896A, except PreS deletion, consecutively increased with increasing age. HBV subgenotypes B2, C1, and C2 are endemic in Mainland China. HBV genotype C exhibits less replication activity in the young and harbors higher frequencies of the HCC-associated mutations than genotype B. These basic data could help evaluate the association of HBV variations with HCC.

Using general growth balance method and synthetic extinct generations methods to evaluate the underreporting of death at disease surveillance points from 1991 to 1998

Using both general growth balance (GGB) and synthetic extinct generations (SEG) methods to evaluate the underreporting of deaths in disease surveillance points (DSP) from 1991 to 1998. We used those two methods to estimate the underreport rate in DSP from 1991-1998. According to GGB method, death rate and the difference between entry rate and growth rate were regarded as independent and dependent variable, respectively, to fit a one-dimensional linear equation n(*)(x) - r(*)(x+) = [ln(k(1)/k(2))]/t + [(k(1)k(2))(0.5)/c]d(*)(x+). About SEG method, it was calculated by life expectancy at age 85 of national census in 2000 and an equation N(x) = integral(x)(infinity)D(a).exp[integral(x)(a)r(u)du]d(a). Then we drew scatter diagram to evaluate underreporting of average intercensal age-specific mortality rates, and made adjustment. By GGB method, the population count in 1998 was 87.29 percent as complete as the count in 1991. For the period of 1991 - 1998, the number of underreporting of deaths was 11.7 percent. The underreporting of average intercensal age-specific mortality rates was not high. However, when SEG method was used, the underreport rate became 48.0 percent. The underreporting of average intercensal age-specific mortality rates decreased significantly from younger to older age groups. GGB and SEG could reduce more cost than other underreporting-related survey, and evaluate the underreporting in a defined time period. GGB could also evaluate the underreporting rate of population and death. However, both these two methods had some limitations. There was big difference between the results when using SEG and GGB, suggesting that we should try to combine GGB and SEG methods to get the better results.

Surveillance and control of Japanese encephalitis in Henan province, 1950 - 2008

To analyze the characteristics and trend of Japanese encephalitis (JE) in Henan province. Adopting descriptive epidemiological method to analyze the data on the epidemic situation of JE from 1950 to 2008, and on mosquitoes and host animals at disease surveillance points. The host serum JE IgG antibody was detected by ELISA. Data was analyzed using SPSS 12.0 and Excel 2003 software. The incidence of JE in Henan province had a fluctuant downward trend. Peak of the incidence fell in July to September, accounting for 88.09% of total cases. The scope of geographical distribution was increasing from northern to southern parts of the province. Cases mainly concentrated in the southern and south-eastern parts of the province. 0 - 14 year-old group had the highest incidence (81.95%). In Luoyang city, there was a significant increase in children at 15-years or older (58.93%). Most patients were farmers (42.33%). The positive-times for half of the antibodies of JE in piglets of the surveillance sentinels were different, which might be the reason for the different levels for the incidence rates. The proportion of different kinds of mosquitoes were also different in surveillance sentinel sites, and the time for the density peak of the mosquitoes was in accordance with the incidence peak of JE. To develop control strategies, evidence should be based on the characteristics of geographical variance, age, occupation differences, data related to monitoring on animal host and media mosquitoes of JE incidence in Henan province.

Counting the dead in China

Cause-of-death data are playing an increasingly important role in the public health policy of China. When we have this kind of information we can see how patterns have changed says Dr Wu Fan Director of the National Center for Chronic and Noncommunicable Disease Control and Prevention Chinas Center for Disease Control and Prevention (CDC). Recently CDC took part in a research project led by the Center for Statistics of the Ministry of Health on the disease burden and long-term health problems in China; the results were dramatic. Now we know that infectious diseases are lower and noncommunicable diseases are greater and that in rural areas injuries are increasing. We can know which population has major problems and so we can target them and we can know which diseases will have a long-term impact. This helps us to understand what our priorities should be. Cause-of-death data have led to a better understanding of changing disease patterns in China but public health officials are still forced to hazard a guess at disease patterns in the less-developed west where mortality data are scant to non-existent. China has two systems to count deaths: the Ministry of Health (MOH) vital registration system and the disease surveillance point (DSP) system which is monitored by the countrys CDC. (excerpt)

Mortality registration and surveillance in China: History, current situation and challenges

BackgroundMortality statistics are key inputs for evidence based health policy at national level. Little is known of the empirical basis for mortality statistics in China, which accounts for roughly one-fifth of the world's population. An adequate description of the evolution of mortality registration in China and its current situation is important to evaluate the usability of the statistics derived from it for international epidemiology and health policy.Current situationThe Chinese vital registration system currently covers 41 urban and 85 rural centres, accounting for roughly 8 % of the national population. Quality of registration is better in urban than in rural areas, and eastern than in western regions, resulting in significant biases in the overall statistics. The Ministry of Health introduced the Disease Surveillance Point System in 1980, to generate cause specific mortality statistics from a nationally representative sample of sites. Currently, the sample consists of 145 urban and rural sites, covering populations from 30,000 – 70,000, and a total of about 1 % of the national population. Causes of death are derived through a mix of medical certification and 'verbal autopsy' procedures, applied according to standard guidelines in all sites. Periodic evaluations for completeness of registration are conducted, with subsequent corrections for under reporting of deaths.ConclusionResults from the DSP have been used to inform health policy at national, regional and global levels. There remains a need to critically validate the information on causes of death, and a detailed validation exercise on these aspects is currently underway. In general, such sample based mortality registration systems hold much promise as models for rapidly improving knowledge about levels and causes of mortality in other low-income populations.

Smoking among adolescents in China: 1998 survey findings.

In China, tobacco smoking accounts for approximately 800 000 deaths annually and evidence suggests that tobacco use is rising. To improve tobacco control initiatives directed at youth, we conducted a population-based survey of children ages 11-20 years, both in and out of school. While there have been previous school-based studies on smoking prevalence and smoking-related knowledge, attitudes, and behaviours among adolescents in China, including the Global Youth Tobacco Survey, this survey also describes smoking behaviour among non-student youth. This population is important as approximately 40% of Chinese youths aged 15-19 years have already discontinued their studies. A survey of smoking behaviour and smoking-related knowledge and attitudes was administered to 24 000 youths (students and non-students of middle school age) in 24 disease surveillance points in China, selected to include equal numbers of urban and rural children. The prevalence rates of experimenting were 47.8% for boys and 12.8% for girls. The prevalence of regular smoking among non-students was higher (8.3%) compared with students (5.2%). The strongest predictor of regular smoking was peer influence with 44% reporting that they obtained their first cigarette from peers. The majority of youths were aware that smoking was a cause of several diseases and addictive; however, non-students were less aware than students. The evidence highlights the need for tobacco control interventions aimed at youths in China including non-student youths. For males, prevention programmes should extend into young adulthood.

Pancreatic cancer mortality in China (1991-2000).

To describe the mortality rate of pancreatic cancer and its distribution in China during the period of 1991-2000. Based on the data of demography and death collected through China's Disease Surveillance Point System (DSPS) over the period of 1991-2000, the distribution of death rate of pancreatic cancer was described in terms of age group, gender, calendar year, rural/urban residence and administrative district. A total of 1,619 death cases attributed to pancreatic cancer (975 men and 644 women) were reported by DSPS during 1991-2000. The reported, adjusted and age-standardized mortality rates increased from 1.46, 1.75, and 2.18 per 100,000 populations in 1991 to 2.38, 3.06, and 3.26 per 100,000 populations in 2000. The majority (69.62 %) of the deaths of pancreatic cancer were seen in the age group of 60 years and older. The mortality rate was higher in men than in women, but the male to female death rate ratios decreased during the 10 years. Our data also showed that the death rate of pancreatic cancer in urban areas was about 2-4 fold higher than that in rural areas, and in Northeast and East China, the death rates were higher than those in the other 5 administrative districts. The death rate due to pancreatic cancer was rising during the period of 1991-2000 and the peak mortality of pancreatic cancer might arrive in China.

Mortality and incidence trends from esophagus cancer in selected geographic areas of China circa 1970-90.

China was one of the countries with the highest esophagus cancer risk in the world during the 1970s. This report provides data on time trends of esophagus cancer incidence and mortality during the 1970s-90s in selected geographic areas of China. Information on newly diagnosed cancer cases and cancer deaths is based on data collected by local population-based registries and Disease Surveillance Points (DSP). For the whole country, esophagus cancer mortality decreased slightly, 17.4 per 10(5) populations during 1990-92 in contrast to 18.8 per 10(5) populations in 1973-75. In the Linxian area, trends in the incidence and mortality rates for esophagus+gastric cardia cancer reversed over time; incidence rates increased significantly during 1959-72 but were decreased significantly on average -2.26% (95% Confidence Interval [CI]: -1.74, -2.77) and -1.10% (95% CI = -0.58, -1.62) per year for males and females, respectively, during 1972-97. In urban Shanghai, incidence trend for esophagus cancer decreased monotonically and significantly on average by -4.99% (95% CI = -4.28, -5.70) and -5.18% (95% CI = -4.99, -5.70) per year for males and females, respectively. In Nanao islet, esophagus+gastric cardia cancer mortality rates increased during 1970-82 but decreased slowly from 1982-99 (-0.96% per year; 95% CI = -0.14, -1.78). Our study indicates that incidence and mortality rates for esophagus or esophagus+gastric cardia cancer are now decreasing in China. The declines may be due to an unplanned success of prevention, such as changes in population dietary patterns and food preservation methods.

Smoking cessation in China: findings from the 1996 national prevalence survey

OBJECTIVESTo describe patterns of smoking and smoking cessation in China within the context of the stages of change model, using data from the 1996 national prevalence survey.DESIGNA cross sectional survey...

Survey of coverage, strategy and cost of hepatitis B vaccination in rural and urban areas of China.

AIM:In order to understand the coverage, immunization strategy and cost of hepatitis B (HB) vaccination of China in recent years.METHODS:A two-stage household random sampling method was used in the survey.RESULTS:The survey carried out at 112 Disease Surveillance Points (DSPs) of 25 provinces, autonomous regions and municipalities of China in 1996, showed that the coverage rates of HB vaccination among neonates were 96.9% in the urban DSPs and 50.8% in the rural DSPs in 1993-1994,while in students aged 7-9 years, they were 85.8% and 31.5% in 1994, respective-ly. Up to 1994, 97.5% of the urban DSPs and 73.9% of the rural DSPs on a neonate vaccination against HB program were included in EPI. About 93% of the urban DSPs and 44% of the rural DSPs did HBsAg and HBeAg screening for all or part of pregnant women. The neonates received the regimen of high-dose HB vaccine in combination with hepatitis B immune globin (HBIG) if their mothers were HBsAg and/or HBeAg positive in pregnancy,otherwise they received the low-dose vaccine (10&mgr;gX3). Part of DSPs had a lower neonate coverage due to unreasonable allocation of the vaccines (used for adults not at risk) or higher cost or insufficient supply of the vaccines. It is necessary to evaluate the quality of serological lab test to HBVMs in the maternal prescreening.CONCLUSION:Remarkable achievements have been made according to the national planning and policy of HB immunization in China.

Smoking in China: findings of the 1996 National Prevalence Survey.

As the world's largest producer and consumer of tobacco products, China bears a large proportion of the global burden of smoking-related disease and may be experiencing a tobacco epidemic. To develop an evidence-based approach supporting tobacco control initiatives in China. A population-based survey consisting of a 52-item questionnaire that included information on demographics, smoking history, smoking-related knowledge and attitudes, cessation, passive smoke exposure, and health status was administered in 145 disease surveillance points in the 30 provinces of China from March through July 1996. A nationally representative random sample of 128766 persons aged 15 to 69 years were asked to participate; 120298 (93.8%) provided data and were included in the final analysis. About two thirds of those sampled were from rural areas and one third were from urban areas. Current smoking patterns and attitudes; changes in smoking patterns and attitudes compared with results of a previous national survey conducted in 1984. A total of 41187 respondents smoked at least 1 cigarette per day, accounting for 34.1% of the total number of respondents, an increase of 3.4 percentage points since 1984. Current smoking continues to be prevalent among more men (63%) than women (3.8%). Age at smoking initiation declined by about 3 years for both men and women (from 28 to 25 years). Only a minority of smokers recognized that lung cancer (36%) and heart disease (4%) can be caused by smoking. Of the nonsmokers, 53.5% were exposed to environmental tobacco smoke at least 15 minutes per day on more than 1 day per week. Respondents were generally supportive of tobacco control measures. The high rates of smoking in men found in this study signal an urgent need for smoking prevention and cessation efforts; tobacco control initiatives are needed to maintain or decrease the currently low smoking prevalence in women.