National Disease Surveillance Points Research Articles

Trends of Cause-Specific Mortality and Association with Economic Status, Education Level, as Well as Health Investment among Adolescents Aged 10 to 24 Years in China, 2004–2019

Objective: To describe the secular trends of cause-specific mortality among adolescents aged 10 to 24 years from 2004 to 2019 and explore the association between mortality and economic status, education level as well as health investment. Methods: Mortality data of adolescents aged 10 to 24 years were obtained from the national disease surveillance points system. The age-standardized mortality rate (ASMR) was calculated by using the population data from the sixth national population census in 2010. GDP per capita, urbanization rate, illiteracy rate of the population over 15 years old, government education expenditure per capita, number of health service providers per 1000 people, and number of health beds per 1000 people were collected from China’s Economic and Social Big Data Research Platform. Age-period-cohort analysis was used to analyse the net age, period, and cohort effects of mortality among adolescents, while panel data regression was used to explore the association between mortality and economic status, education level as well as health investment. Results: Overall, the ASMR was 28.84 per 100,000 and the top five causes of mortality were road injuries, drowning, intentional self-harm and sequelae, leukaemia, and falls among adolescents aged 10 to 24 years in China in 2019. All-cause mortality declined with an annual percentage change of 4.02% (95% Confidence interval: 3.74% to 4.30%) from 2004 to 2019 yet with persistent differences across different demographic (gender and age) and geographical (urban-rural, and regional) subgroups. Notably, the ASMR for HIV/AIDS in males, lower respiratory infections in urban adolescents, and iron deficiency anaemia as well as cervical cancer in adolescents aged 20 to 24 years showed an increase over time. The multivariate panel data regression showed that the ASMR decreased by 5.18 (3.27, 7.08) per 100,000 for every increase in the number of health beds per 1000 population, but with insignificant association with GDP per capita and illiteracy rate in the total sample. Health beds investment was positively associated with ASMR at almost all subgroups except for adolescents aged 10 to 14 years; GDP per capita increase was helpful to males and rural adolescents while an increasing literacy rate was beneficial for females and adolescents aged 15 to 19 years. Conclusion: Given the persistent differences between subgroups, further investments including improving health services, especially increasing health bed investment, GDP per capita, and reducing the illiteracy rate and concern for adolescents in males, rural areas, the western regions, and aged 15 to 24 years are needed. Additionally, the increased burden of some diseases, such as HIV/AIDS, must be of further concern.

Data Resource Profile: China Chronic Disease and Risk Factor Surveillance (CCDRFS).

Reliable and timely information on chronic and non-communicable diseases (NCDs) and their risk factors are fundamental for informing the development, implementation and evaluation of NCDs-related health policy. The China Chronic Disease and Risk Factor Surveillance (CCDRFS) is series of ongoing periodical nationally representative cross-sectional surveys among Chinese adults on their chronic health conditions (e.g. hypertension, diabetes, dyslipidaemia, stroke, myocardial infarction, cancer and chronic obstructive pulmonary disease) and related risk factors (e.g. smoking, harmful drinking, physical inactivity and unbalanced diet). The CCDRFS is established and organized by the National Centre for Chronic and Noncommunicable Disease Control and Prevention (NCNCD), the Chinese Centre for Disease Control and Prevention (China CDC), incorporated into the national Disease Surveillance Points (DSPs) system. A DSP area covers one rural county or one urban district. The details of the DSPs system have been reported elsewhere.1,2 Since its establishment in 2004, the CCDRFS was incorporated into the DSPs system, using its surveillance point as the primary sampling unit (PSU) in a multistage sampling framework. At the time of writing this paper, six field surveys had been carried out in 2004 (79 DSPs), 2007 (161 DSPs), 2010 (161 DSPs), 2013 (298 DSPs), 2015 (298 DSPs) and 2018 (298 DSPs). Figure 1 shows the locations of the CCDRFS surveillance points before and after expansion.

E-cigarette use among adults in China: findings from repeated cross-sectional surveys in 2015–16 and 2018–19

The use of e-cigarettes among adults is increasing globally. Since 2018, policies in China have restricted e-cigarette use; however, little information is available on the national trend in e-cigarette use before regulations were implemented. Therefore, we sought to estimate the trend in e-cigarette use in China before policy implementation and explored associated factors. We assessed two nationally representative cross-sectional datasets from the China Chronic Disease and Nutrition Surveillance (CCDNS) surveys initiated in 2015 (June, 2015, to May, 2016) and 2018 (August, 2018, to June, 2019). The surveys were done at 298 national disease surveillance points in 31 provinces in mainland China, and used a multistage, stratified, cluster-randomised sampling design, recruiting community-based Chinese adults aged 18 years and older. Within the standard CCDNS survey, face-to-face questionnaire interviews were used to collect self-report data on e-cigarette use in the preceding 30 days. E-cigarette users were those who self-reported e-cigarette use on 1 day or more in the past 30 days. Prevalence estimates of past 30-day e-cigarette use were weighted to represent the Chinese adult population accounting for the complex sampling design. Populations for the years 2015-16 and 2018-19 were standardised with the 2010 population census to gain comparable estimates. Multivariable logistic regression models adjusted for age, sex, urban or rural residence, household income, occupation, and education level were applied to identify factors associated with the likelihood of e-cigarette use among the total population, ever smokers (current and former), and never smokers across both surveys. Our study included 189 306 Chinese adults from the 2015 survey (100 405 [53·0%] women; mean age 43·6 years [SD 14·6]) and 184 475 Chinese adults from the 2018 survey (102 373 [55·5%] women; mean age 43·4 years [13·9]). The weighted prevalence of past 30-day e-cigarette use among Chinese adults increased from 1·3% (95% CI 1·1-1·5%) in 2015-16 to 1·6% (95% CI 1·4-1·8%) in 2018-19 (an increase of 0·3% [95% CI 0·1-0·6]; Rao-Scott χ2 p=0·0086). Based on weighted proportion data, e-cigarette users were predominantly men (97·4% [95% CI 96·7-98·1] in 2015-16 and 97·0% [95·4-98·6] in 2018-19) and current conventional smokers (93·0% [90·7-95·2] in 2015-16 and 96·2% [95·1-97·3] in 2018-19). Across both surveys, the odds of e-cigarette use were significantly associated with obesity (odds ratio 1·6 [95% CI 1·3-2·1]; p=0·0007), awareness of smoking hazards (1·2 [1·0-1·4]; p=0·022), and smoking status (in current smokers, 135·2 [87·7-208·6]; and in former smokers, 33·5 [21·3-52·7]; p<0·0001). Among current smokers, the odds were increased with daily cigarette consumption (2·1 [1·5-2·8]; p<0·0001), smoking more than 20 cigarettes per day (1·8 [1·5-2·3]; p<0·0001), and an attempt to quit smoking (within the past 12 months, 1·9 [1·5-2·4]; and before the past 12 months, 1·5 [1·3-1·9]; p<0·0001). In never smokers, the odds were increased in those aware of the hazards of smoking (2·4 [1·2-4·7]; p=0·011). E-cigarette use in China remains low but has increased substantially between 2015 and 2019. Our study identified increased e-cigarette use among subpopulations, and use patterns, that warrant further attention from public health policy makers in China. Chinese Central Government, National Key Research and Development Program of China.

Comparison and Analysis of Epidemiologic Characteristics of Stroke in Sichuan Province, China.

Previous studies have shown that there is a geographic variation in the prevalence of stroke, with a lower prevalence of stroke in Sichuan province. And a stroke transition was found during the period of economic development as well. However, as the center of Southwest China, with a greatly developed economy, whether the geographic variation remained with lower burden of stroke in Sichuan province is unknown. Therefore, in this study, we analyzed the secular stroke status in Sichuan province to help explore the potential reasons for geographic disparity. From a cross-sectional study conducted based on eight national disease surveillance points (DSPs) in Sichuan province in 2013, the epidemiologic data of stroke were collected. Data of risk factors were obtained from a cross-sectional study based on 12 national DSPs in Sichuan province in 2013. The results showed that the age-standardized prevalence, incidence, and mortality of stroke in Sichuan province were 338.6/100,000 people [95% confidence interval (CI), 267.8–409.4], 147.1/100,000 person-years (95% CI = 100.6–193.6), and 72.4/100,000 person-years (95% CI = 40.0–104.8), respectively, which were significantly lower than those determined from the contemporary data of China in 2013. The analysis of the risk factors showed that the weights of contribution of the potential risk factors to stroke were in consistency with those published reports from other areas. In conclusion, the disparity of lower stroke burden in Sichuan than the average China remained, although with the great developments in Sichuan province over all those decades. In addition to traditional modifiable factors, we suggest that unknown or intrinsic differences such as genetic factors might play an important role in geographic disparity, which should be investigated in future studies.

Road traffic mortality in China: analysis of national surveillance data from 2006 to 2016

Sustainable Development Goal (SDG) 3.6 is to halve the number of global deaths and injuries from road traffic accidents by 2020. We aimed to investigate progress in reducing mortality rates from road traffic injury in China from 2006 to 2016. We obtained data from national disease surveillance points. Crude and age-standardised mortality were calculated, with SEs. Joinpoint regression analysis was used to examine and quantify trends in overall and subgroup road traffic mortality from 2006 to 2016. Subgroup analyses were done by place (urban and rural), sex, age group, geographical location (province), and road user, and by type of vehicle for motor vehicle occupant deaths. In 2016 in China, crude road traffic mortality was 11·0 (SE 0·11) deaths per 100 000 population. Overall age-adjusted road traffic mortality increased from 12·6 (SE 0·03) deaths per 100 000 population in 2006 to 15·5 (0·03) deaths per 100 000 population in 2011 then decreased to 10·4 (0·03) deaths per 100 000 population in 2016. Subgroup mortality rates generally followed similar trends. Males, older adults, and rural areas consistently had higher road traffic mortality rates than did females, younger people, and urban areas. Mortality changes varied across urban and rural areas and by sex, age group, and province between 2006 and 2016, revealing large urban-rural and provincial disparities and highlighting pedestrians as the most vulnerable road users. Deaths among occupants of cars and three-wheeled motor vehicles constituted 48% and 20%, respectively, of total occupant mortality from road traffic accidents between 2006 and 2016. Despite a substantial decrease in road traffic mortality since 2011, the SDG target to halve deaths and injuries from road traffic accidents by 2020 is unlikely to be reached in China. Systematic and sustainable efforts are needed to accelerate progress in road traffic safety in China. National Natural Science Foundation of China.

The Epidemiological Characteristics of Stroke in Hunan Province, China.

Previous studies have shown that Hunan Province has a high incidence of stroke and a high proportion of intracerebral hemorrhage (ICH). Considering the changes over the past three decades, little is known about the current epidemiological characteristics of stroke in Hunan Province. In 2013, a cross-sectional study was conducted at seven national disease surveillance points (DSPs) in Hunan Province. A multistage cluster sampling method was used to select a representative sample. A total of 21,156 participants aged 20 years and older were examined. Among the 21,156 participants, the number of prevalent strokes, incident strokes and deaths was 307, 87, and 36, respectively. The 2010 China census-standardized prevalence, incidence and mortality were 1191.0 per 100,000 people [95% confidence interval (CI) 1044.8–1337.2], 333.6 per 100,000 person-years (95% CI 255.7–411.5) and 129.7 per 100,000 person-years (95% CI 81.1–178.3), respectively. Ischemic stroke (IS), ICH, subarachnoid hemorrhage (SAH), and stroke of undetermined type (UND) constituted 50.6, 41.4, 5.7, and 2.3% of all incident stroke cases, respectively. Tianxin, Liuyang, Wuling, and Hongjiang have high proportions of ICH (61.5, 58.3, 60, and 50%, respectively). Hypertension is the most common risk factor for prevalent stroke (71.34%), followed by smoking (30.62%) and alcohol use (25.73%). In conclusion, Hunan Province has an extremely heavy stroke burden. The high proportion of ICH is not limited to the Changsha community; it represents an important issue for all of Hunan Province.

Poisoning deaths in China, 2006-2016.

ObjectiveTo provide a comprehensive overview of poisoning mortality patterns in China.MethodsUsing mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences over time between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately.ResultsIn 2016, there were 4936 poisoning deaths in a sample of 84 060 559 people (5.9 per 100 000 people; 95% confidence interval: 5.6–6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100 000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100 000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25–64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25–44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females.ConclusionDespite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations.

Epidemiological serosurvey of hepatitis B in national disease surveillance points of Henan province in 2014

Epidemiological serosurvey of hepatitis B in national disease surveillance points of Henan province in 2014

Analysis on death causes of residents in Anhui province, 2013

To analyze the demographic characteristics and the death causes of the residents in Anhui province, and provide evidence for the disease prevention and control. Using descriptive epidemiological analysis, the demographic characteristics and death data of the national disease surveillance points (DSPs) in Anhui province in 2013 were analyed by areas. The aging of the population was observed in all the areas in Anhui, which was most obvious in Jianghuai, followed by Wannan and Huaibei. The overall mortality was 627.10/100 000. The mortalities of diseases varied with sex, area and age. Among the 3 areas, the overall mortality, chronic disease mortality and injury mortality were highest in Huaibei and lowest in Wannan. The area specific difference in mortality of infectious diseases was small. Regardless of areas or the types of diseases, the mortality was higher in males than in females. Deaths caused by diseases with unknown origins were common in residents aged >65 years. The mortality of chronic diseases was higher in residents aged >45 years, especially in those aged 65-84 years. The mortality of injuries was higher in age groups >15 years and >45 years. The mortality of infectious diseases peaked at both young age group and old age group. The top five death causes were cerebrovascular diseases, malignant tumors, heart diseases, respiratory diseases and injuries. Regardless of sex or area, the major death causes were similar, but the ranks were slightly different. The major death causes varied in different age groups, but they were similar in same age group in different areas. The major death causes were diseases originated in perinatal period, and congenital malformations, deformations and chromosomal abnormalities in children aged <1 year. The major death causes in children aged 1-14 years were injuries, diseases originated in perinatal period, congenital malformations, deformations and chromosomal abnormalities. Injuries and malignant tumors were the first and second death causes in residents aged 15-44 years. Malignant tumors, injuries, cerebrovascular diseases and heart diseases were the major death causes in residents aged 45-64 years. The major death causes were cerebrovascular diseases, malignant tumors, heart diseases and respiratory diseases in residents aged 65-84 years and heart diseases, cerebrovascular diseases, respiratory diseases and malign tumors in residents aged≥85 years. The major death causes in residents in Anhui province were cerebrovascular diseases, malignant tumors and injuries. Close attention should be paid to the prevention and control of cerebrovascular diseases, malignant tumors and heart diseases in age group≥45 years. It is necessary to strengthen the prevention and control of injuries in age group 15-44 years. Huaibei is a key area of disease prevention and control in Anhui, especially chronic disease and injury preventions.

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

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.

Prevalence of hepatitis B and C virus infections in the general Chinese population. Results from a nationwide cross-sectional seroepidemiologic study of hepatitis A, B, C, D, and E virus infections in China, 1992

Viral hepatitis is a major public health problem in China and has a substantial impact on the health of people. To understand the distribution of hepatitis virus infection in the general Chinese population and provide basis for developing and evaluating preventive procedures and public health practices on viral hepatitis control, a nationwide cross-sectional seroepidemiologic study of hepatitis virus infections was carried out in China, 1992. Using two-stage cluster sampling, a total of 68 000 subjects were studied, aged 1–59 years, covering all 145 national disease surveillance points of 30 provinces, autonomous regions and municipalities. Serum specimens were assayed using commercial reagents. Tested markers include HBsAg, anti-HBc, anti-HBs, HBeAg and anti-HCV. The overall prevalence of HBsAg carrier was 9.75% of 61 702 subjects studied (range 4.49–17.85%) in 30 provinces of China. The rate in the 1–4 age group was as high as the overall rate. There were higher rates in both the 10–14 and 30–34 age groups, and lower in the 50–59 age group. There were considerable variations in the prevalence of HBsAg carrier in different regions and sex in China, with the highest rate being in middle south and lower rates in north China. The overall prevalence of HBV infection, anti-HBc and anti-HBs were 57.63%, 49.81% and 27.42%, respectively; increasing significantly with age from 38.47%, 30.08% and 15.75% in the 1–4 age group to 70.69%, 61.77% and 32.42% in 50–59 age group, respectively. The overall prevalence of HBeAg was 31.94% among HBsAg carriers. The overall prevalence of anti-HCV was 3.2% of 66975 subjects studied (range 0.9–5.1%) among 30 provinces of China, increasing significantly with age from 2.08% in the 1–4 age group to 3.96% in the 50–59 age group. There was no difference in the rate of anti-HCV by sex and living district. However, there were significant difference in rates of anti-HCV in different geographical areas and administrative divisions in China, with the highest rates being in the northeast of China. These results indicate that hepatitis B and C are hyperendemic in China. According to characteristics of distribution among age, sex and regions, we suggest that the main modes of transmission of the two virus are probably different in China.