Chronic Disease Survey Research Articles

Untangling pathways of risk factors associated with hypertension among dysglycemia adults in eastern China: a structural equation model approach.

Using structural equation model (SEM) to test a conceptual model of pathways of developing hypertension among dysglycemia (IFG and T2DM) adults in Eastern China, emphasizing the unique mediation effect of insulin resistance and obesity on the relationship between modified/unmodified factors and hypertension. Participants with dysglycemia (n = 10,401) were extracted from the survey of Chronic Disease and Risk Factor Surveillance in Nanjing, the capital of Jiangsu Province in China. Dietary patterns were identified by using principal component analysis (PCA). SEM was employed to evaluate multiple pathways of hypertension among participants with IFG and T2DM. Three dietary patterns were derived using PCA. The tuber animal food pattern (OR = 0.825, 95% CI 0.723-0.940) and the balanced food pattern (OR = 0.812, 95% CI 0.715-0.922) were negatively associated with hypertension, while the Chinese rural food pattern (OR = 1.163, 95% CI 1.019-1.328) was positively associated with hypertension. The best SEM model showed that BMI (0.140), smoking (0.048) and Chinese rural food pattern (0.022) positively associated with hypertension; while tuber animal food pattern (- 0.025) had a negative direct effect on hypertension. Notably, insulin resistance could mediate the link between lifestyles (smoking and dietary patterns) and hypertension. Accordingly, we emphasized the importance of lifestyle intervention, mainly including obesity management, choosing healthy diets and decreasing smoking control, which may profoundly benefit this high-risk group among Chinese population.

Study on the incidence and influencing factors of prediabetes in Chinese adults

Objective: To explore the incidence and influencing factors of prediabetes in adults in China. Methods: Ten provinces (cities) were selected from the surveillance survey of chronic diseases and their risk factors in China in 2010; two monitoring sites were selected from each province (city) as follow-up spots, and a follow-up survey was conducted from 2016 to 2017. An unconditional logistic regression model was used to analyze the influencing factors of prediabetes. Results: A total of 5 578 participants were included in this study. During the follow-up period, 612 patients (268 males and 344 females) developed impaired glucose tolerone (IGT), with a total follow-up of 37 364.82 person-years, and the incidence of IGT was 16.4/1 000 person-years. Impaired fasting glucose (IFG) occurred in 290 patients (128 males and 162 females) with a total follow-up of 39 731.31 person-years, and the incidence of IFG was 7.3/1 000 person-years. The multivariate unconditional logistic regression model included age, urban and rural areas, family history of diabetes, BMI, central obesity, dyslipidemia, hypertension, and physical activity, and the results showed that age (≥50 years old: OR=1.60, 95%CI: 1.32-1.95), urban residents (OR=1.41, 95%CI: 1.16-1.71), obesity (OR=1.56, 95%CI: 1.12-2.19), dyslipidemia (OR=1.52, 95%CI: 1.25-1.83), hypertension (OR=1.32, 95%CI: 1.07-1.61) and physical inactivity (OR=1.25, 95%CI: 1.04-1.50) increase the risk of IGT. Age (≥50 years old: OR=1.31, 95%CI: 1.01-1.70), family history of diabetes (OR=1.71, 95%CI: 1.13-2.60), overweight (OR=1.41, 95%CI: 1.04-1.92), obesity (OR=2.09, 95%CI: 1.38-3.17) and hypertension (OR=1.53, 95%CI: 1.18-2.00) increase the risk of IFG. Conclusions: The incidence of IGT is higher than the IFG. People aged 50 and above, overweight and obese people, hypertension patients, dyslipidemia patients, people with insufficient physical activity, and family history of diabetes are prone to prediabetic events.

Joint effects of self-reported sleep and modifiable physical activity on risk of dyslipidaemia in women aged 45–55 years: a cross-sectional study

ObjectivesModifiable physical activity (PA) plays an important role in dyslipidaemia risk in middle-aged women with sleep problems, especially perimenopausal women. We aimed to explore the joint effects of sleep and...

Socioeconomic Determinants of Diet Quality on Overweight and Obesity in Adults Aged 40-59 Years in Inner Mongolia: A Cross-Sectional Study.

Objectives: This study investigated the relationship of socioeconomic status (SES), diet quality and overweight and obesity in adults aged 40–59 years in Inner Mongolia. Methods: This cross-sectional study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015. Diet quality was evaluated by the Alternate Mediterranean Diet score (aMeds). SES was measured by household annual income. Generalized estimating equations and path analysis were performed to determine the association of SES, diet quality and overweight and obesity. Results: Among participants, 63.0% had overweight and obesity. In high SES group, 66.4% had overweight and obesity. Higher SES was associated with a higher risk of overweight and obesity (OR = 1.352, 95%CI: 1.020–1.793). And higher aMeds was associated with a lower risk of overweight and obesity (OR = 0.597, 95%CI: 0.419–0.851). There was a positive correlation between SES and the intake of red and processed meat (r = 0.132, p < 0.05). Higher intake of red and processed meat was associated with lower diet quality (β = −0.34). And lower diet quality was associated with a higher risk of overweight and obesity (β = −0.10). Conclusion: In Inner Mongolia, during the period of economic transition, people aged 40–59 years in high SES had poor diet quality, which was related to a higher risk of overweight and obesity.

Dietary quality is associated with reduced risk of diabetes among adults in Northern China: a cross-sectional study.

In this study, we analysed the prevalence of diabetes in Inner Mongolia and explored the relationship between dietary patterns and diabetes using the Chinese Dietary Balance Index-16 (DBI-16). This study was a surveillance survey of Chronic Disease and Nutrition Monitoring among Chinese Adults in Inner Mongolia in 2015. Dietary data were collected using the 24-h dietary recall and weighing method over three consecutive days. Dietary quality was evaluated via the DBI-16. A generalised linear model was used to examine the associations between the DBI-16 and dietary patterns. The relationship between dietary patterns and diabetes was analysed using logistic regression. In Inner Mongolia, the diabetes prevalence was 8·5 % and the estimated standardised prevalence was 6·0 %. Four major dietary patterns were identified: 'meat/dairy products', 'traditional northern', 'high cereal/tuber' and 'high-salt/alcohol'. Generalised linear models showed that the 'meat/dairy product' pattern was relatively balanced (βLBS = -1·993, βHBS = -0·206, βDQD = -2·199; all P < 0·05) and was associated with a lower diabetes risk (OR 0·565; 95 % CI 0·338, 0·945; P < 0·05) after adjusting for potential confounders. The other three dietary patterns (i.e. 'traditional northern', 'high cereal/tuber' and 'high-salt/alcohol') exhibited relatively unbalanced dietary quality and were unassociated with diabetes risk. Diabetes prevalence in Inner Mongolia was moderate. The dietary quality of the 'meat/dairy product' pattern was relatively balanced and was correlated with a decreased risk of diabetes prevalence, suggesting that dietary quality may help decrease diabetes prevalence and provide a suggestion for local dietary guidelines.

Association between Selenium in Soil and Diabetes in Chinese Residents Aged 35–74 Years: Results from the 2010 National Survey of Chronic Diseases and Behavioral Risk Factors Surveillance

ObjectiveTo explore the association between soil selenium levels and the risk of diabetes in Chinese adults aged 35–74 years. MethodsData for this study were derived from the China Chronic Diseases and Behavioral Risk Factors Surveillance 2010 survey. Selenium concentrations in soil were obtained from the Atlas of Soil Environmental Background Values in China. A two-level binary logistic regression model was used to determine the association between soil selenium concentrations and the risk of diabetes, with participants nested within districts/counties. ResultsA total of 69,332 participants aged 35–74 years, from 158 districts/counties were included in the analysis. Concentrations of selenium in soil varied greatly across the 158 districts/counties, with a median concentration of 0.219 mg/kg (IQR: 0.185–0.248). The results showed that both Quartile 1 (0.119–0.185 mg/kg) and Quartile 4 (0.249–0.344 mg/kg) groups were positively associated with diabetes compared to a soil selenium concentration of 0.186–0.219 mg/kg (Quartile 2), crude odds ratios (ORs) (95% CI) were 1.227 (1.003–1.502) and 1.280 (1.048–1.563). The P values were 0.045 and 0.013, for Quartile 1 and Quartile 4 groups, respectively. After adjusting for all confounding factors of interest, the Quartile 1 group became non-significant, and the Quartile 4 group had an adjusted OR (95% CI) of 1.203 (1.018–1.421) relative to the reference group (Quartile 2), the P values was 0.030. No significant results were seen for the Quartile 3 group (0.220–0.248 mg/kg) compared to the reference group. ConclusionExcessive selenium concentrations in soil could increase the risk of diabetes among Chinese adults aged 35–74 years.

Prevalence, knowledge and education level associated with secondhand smoke exposure among never-smoking women in Inner Mongolia, Northern China.

INTRODUCTIONCurrently, 40.7% of women in China are exposed daily to secondhand smoke (SHS); however, research on SHS exposure among women in Inner Mongolia is limited. We aimed to investigate the prevalence of SHS exposure, knowledge about the harms of smoking and SHS, and the association between sociodemographic factors and SHS exposure among never-smoking women in Inner Mongolia, Northern China.METHODSThis study was based on a survey of chronic disease and nutrition conducted among Chinese adults in Inner Mongolia during 2015, a cross-sectional study with multi-stage stratified cluster sampling. A total 2293 never-smoking women aged ≥18 years were included in the study. Face-to-face interviews were used to collect data of sociodemographic characteristics, SHS exposure, and related knowledge. Questionnaires were administered by trained investigators, and the reliability and validity of the questionnaires were high. We performed descriptive analysis and logistic regression. All analyses were performed by IBM SPSS Statistics version 19.0.RESULTSOf the total, 69% of young women in Inner Mongolia in 2015 reported that they were exposed to SHS, the highest rate in comparison with older and middle-aged women. A total 49.90% of young women reported being exposed to SHS every day. Respondents had insufficient knowledge regarding smoking and SHS exposure. Compared with older never-smoking women, their young counterparts had a higher risk of SHS exposure, with an odds ratio of 2.143 (95% CI: 1.647–2.787). Education level and ethnicity were also significantly associated with SHS exposure.CONCLUSIONSThis study showed that the highest rates of SHS exposure were among young never-smoking women in Inner Mongolia, and women with high education levels were less likely to be exposed to SHS. Improved public health information is needed that prioritizes SHS exposure among young women in Inner Mongolia. Health education regarding SHS exposure should be widely implemented throughout communities in this region.

Dietary patterns in relation to major cardiovascular diseases risk factors

PurposeThe purpose of this study was to evaluate the association of empirically derived dietary patterns with hypertension and hyperlipidemia among a large sample of Iranian industrial employees.Design/methodology/approachThis cross-sectional study was done under the framework of Epidemiological Survey of Chronic Diseases on Manufacturing Employees. Major dietary patterns were derived based on a validated short form of food frequency questionnaire (FFQ) using exploratory factor analysis. Self-administered validated questionnaires were used to collect data on socio-demographic and job-related variables of participants. Multivariable logistic regression was applied for association analyses.FindingsHigher levels of Western dietary pattern increased significantly the risk of hypertension (odds ratio [OR] = 1.85, 95% CI [1.36-2.53], P trend <0.001) and hyperlipidemia (OR = 1.45, 95% CI [1.16-1.81], p = 0.001) even after controlling for confounding variables. The traditional dietary pattern was marginally associated with a significant increase in risk of hyperlipidemia ( = 1.14, 95% CI [0.92-1.41], p = 0.084) in the fully adjusted model. However, higher levels of healthy dietary pattern were significantly associated with a decreased risk of hyperlipidemia in the final model (OR 0.80, 95% CI [0.64-0.90], p = 0.025).Originality/valueTo the authors’ knowledge, an association analysis between dietary patterns and major cardiovascular disease risk in workforce population over the world is scarce and has not yet been conducted among Iranian industrial employees. This study’s findings are especially relevant for the industrial workforce population because they are at high risk of other job-related risks that increase the CVD risk.

Epidemiological survey of chronic diseases on manufacturing employees (ESCOME): Design and methodology of a large cross-sectional study

Background and objectivesThe epidemiological survey of chronic diseases on manufacturing employees (ESCOME) was designed to a) assess the prevalence of chronic physical and mental diseases b) investigate socio-demographic, psychological and lifestyle determinants of chronic physical and mental diseases c) investigate job-related determinants of chronic physical and mental diseases among a large sample of Esfahan steel company (ESCO) employees. MethodsThis cross-sectional study was conducted at 2015 in two main phases among employees of ESCO, Isfahan, Iran. In the first phase, validated self-administered questionnaires were used to assess quality of life, mental health, lifestyle and job-related variables. In the second phase, clinical, biomedical and anthropometric indices were evaluated in the occupational medicine center of ESCO. Furthermore, a self-report questionnaire was used to collect comprehensive information about socio-demographic factors, smoking habits and chronic physical diseases. ResultsTotally, 3063 employees from various departments of ESCO were recruited in the current study. The participants’ mean age was 36.74 years (SD = 7.30, ranged from 21 to 64) and 91.5% of them were male. The participants predominantly worked in rotational shifts (55%) and 63.5% were low-level blue-collar employees. Hyperlipidemia (29.7%) and anxiety (8.9%) were the most prevalent physical and mental diseases respectively. ConclusionsThe ESCOME provided an opportunity to enhance our knowledge about the epidemiology and determinants of chronic physical and mental diseases among Iranian manufacturing employees.

Abstract P343: Patients With Cardiovascular Disease Are Not Meeting American Heart Association Secondary Prevention Recommendations

Introduction: In the United States, cardiovascular disease (CVD) is the leading cause of mortality. More than 92 million Americans have one or more types of CVD and 800,000 die from it annually. More than 47% of myocardial infarction survivors and 30% of stroke survivors get recurrent events, and therefore there is need for data on secondary preventive care, if the AHA’s 2020 impact goal is to be achieved. We assessed the hypothesis that patients with CVD were not meeting AHA secondary preventive guidelines, and there was gender and racial disparities in care. Methods: This study is an analysis of the 2017 Behavioral Risk Factor Surveillance System a chronic disease survey conducted by the CDC. The sample included 51,626 subjects with a history of stroke and coronary artery disease. The secondary preventive measures analyzed included: exercise, diet, smoking cessation, alcohol intake, body mass index, use of blood pressure medications in hypertensive patients and the use of aspirin. Gender and racial disparities were analyzed using multiple logistic regression analysis and age, race, education and income were adjusted for in the outcomes. Results: The median age of the study cohort was 69 years (variance=140). White, black and Hispanic patients represented 79.3%, 8.6% and 6.7% respectively. Females comprised 48.5%. Comorbidities included: hypertension (72.8%), dyslipidemia (63.5%), diabetes mellitus (31.5%) and chronic kidney disease (11.5%). Among CVD patients, 57.1% reported ever smoking and 17.4% of them still smoked. Only 39.2% met AHA aerobic exercise guidelines and 12.1% met both the aerobic and muscle strengthening exercise guidelines. Thirty nine percent of CVD patients undertook more than 150 minutes of aerobic exercise and 12% did 1-149 minutes per week. Obesity/overweight was present in 73.8%. Only 67.8% of patients with CVD were using aspirin, 20% were not on any cholesterol medication (not specified whether statin) while among hypertensive patients, 90.1% were on antihypertensive medications. There were major racial and gender disparities in smoking status [women vs men adjusted OR (aOR) 1.23 (1.21 - 1.25), Hispanic vs white aOR 1.71 (1.66 - 1.76)], aspirin [women vs men aOR 0.66 (0.62 - 0.71), Hispanic vs white aOR 0.56(0.47 - 0.58)]. Women were more likely to be on BP medications [women vs men aOR 1.25 (1.22 - 1.29)]. Conclusion: Patients with stroke do not meet AHA lifestyle and aspirin recommendations. There are major gender and racial disparities in the use of CVD secondary preventive measures.

Abstract 192: Gender and Racial Disparities in Secondary Prevention of Stroke

Introduction: In the US, 795 000 people suffer a stroke and 133 000 die from it annually. Among the survivors, 185 000 get a recurrent stroke. There are gender and racial disparities in stroke mortality and there is need to understand the associated factors, if the AHA’s 2020 impact goal is to be achieved. The objective of this study was to assess the gender and racial differences in the use of secondary preventive measures in patients with stroke, and to identify the associated factors. Methods: This is an analysis of the 2015 Behavioral Risk Factor Surveillance System, a chronic disease survey conducted by the CDC. The sample included 18 269 subjects with stroke. outcomes analyzed included: exercise, diet, smoking cessation, alcohol intake, body mass index, use of blood pressure (BP) medications and the use of aspirin. Gender and racial disparities were analyzed using logistic regression analysis. Age, race, education and income were adjusted for in the outcomes. Results: Women comprised 58.3% of the stroke cohort. White, black and Hispanic respondents represented 75.1%, 11.5% and 4.7% respectively. The mean ages of study subjects were 66.6 and 67 years for men and women respectively. Women were more likely to continue smoking (OR 1.22 (1.13, 1.32)), less likely to meet both the AHA exercise guidelines (OR 0.87 (0.81, 0.94)) and more likely to be obese/overweight (OR 1.45 (1.35, 1.54)). They were also less likely to be on aspirin (OR 0.57 (0.40, 0.80)) and BP medications (OR 0.96 (0.85, 1.09)). Women were more likely to eat ≥1 servings of fruits (OR 1.41 (1.33, 1.50)) and vegetables (OR 1.32 (1.23, 1.40)), were more likely to have health insurance (OR 1.21 (1.04, 1.40)) and clinical provider (OR 1.76 (1.75, 1.76)). Hispanics were more likely to continue smoking compared with whites (OR 1.37 (1.15, 1.63), Blacks and Hispanics were less likely to exercise compared with whites (OR 0.66 (0.61, 0.72) and (OR 0.78 (0.68, 0.88) respectively. Blacks were less likely to eat fruits (OR 0.7 (0.64, 0.76) and vegetables (OR 0.56 (0.51, 0.61) but these effects were attenuated by adjusting for income and education. Conclusion: There are significant gender and racial disparities in secondary stroke preventive measures. Income and education may play an important role in the disparity.

Abstract TMP95: Patients With Stroke Are Not Meeting American Heart Association Secondary Prevention Recommendations

Introduction: Stroke occurs in 795 000 people and causes 133 000 deaths every year in the US. Around 185 000 stroke survivors get recurrent attacks annually. There is a need to understand the adherence to secondary prevention measures if the AHA’s 2020 impact goal is to be achieved. Atherosclerotic cardiovascular disease risk factors remain prevalent in the US but there is limited data on the use of secondary preventive measures among patients with stroke. The objective of this study was to assess the use of secondary preventive measures in patients with stroke and assess for any gender and racial disparities in adherence. Methods: This study is an analysis of the 2015 Behavioral Risk Factor Surveillance System a chronic disease survey conducted by the CDC. The sample included 18 269 subjects with a history of stroke. The secondary preventive measures analyzed included: exercise, diet, smoking cessation, alcohol intake, body mass index, use of blood pressure medications in hypertensives and the use of aspirin. Gender and racial disparities were analyzed using logistic regression analysis and age, race, education, and income were adjusted for in the outcomes. Results: The mean age of the study cohort was 66.8 years (SD =12.1). White, black and Hispanic patients represented 75.1%, 11.5% and 4.7% respectively. Females comprised 58.3%. Comorbidities included: hypertension (73.4%), coronary heart disease (37.5%), dyslipidemia (35.7%), diabetes mellitus (30.4%) and chronic kidney disease (11.6%). Among stroke patients, 57.9% reported ever smoking and 42% of them still smoked. Only 11.3% met both the AHA aerobic and muscle strengthening exercise guidelines. Thirty six percent of stroke patients undertook more than 150 minutes of aerobic exercise and 12% did 1-149 minutes per week. Obesity/overweight was present in 69.9%. Only 59% of patients with stroke were using aspirin while among hypertensive patients, 90.7% took their blood pressure medications. There were major racial and gender disparities in smoking status, obesity, diet, BMI and use of BP medications and aspirin. Conclusion: Patients with stroke do not meet AHA lifestyle modification and aspirin recommendations. There are major gender and racial disparities in the use of stroke secondary preventive measures.

Relationship of Gallbladder Diseases with Sociodemographic Characteristics, Lifestyle, and Chronic Diseases in Northeastern China.

Background: Gallbladder diseases are common in Jilin, China. However, there have been few previous studies on this disease. Our study used the chronic disease database in Jilin Province to study the factors correlated with gallbladder diseases. Methods: A total of 21,435 people were selected from the Jilin Province adult chronic disease survey conducted in 2012. Multistage stratified random cluster sampling was used in this cross-sectional study. Multiple logistic regression analysis was used to explore the independent associations of different factors with gallbladder diseases. Results: There were 1876 people with gallbladder diseases, and the prevalence of the diseases was 8.8% (males 4.4%, females 12.8%). Multivariate logistic regression analysis showed that female (prevalence odds ratio (POR) = 3.13, 95% confidence intervals (CIs): 2.76–3.55), older people (30–45 years (POR = 2.79, 95% CIs: 2.06–3.77), 45–60 years (POR = 4.26, 95% CIs: 3.17–5.73), 60–79 years (POR = 4.72, 95% CIs: 3.48–6.41)), people living in rural areas (POR = 1.65, 95% CIs: 1.49–1.82), smoking (current smoker (POR = 1.15, 95% CIs: 1.01–1.31), former smoker (POR = 1.37, 95% CIs: 1.13–1.66)), high frequency of eating seafood (POR = 0.77, 95% CIs: 0.63–0.93), and high frequency of eating soy products (POR = 0.50, 95% CIs: 0.44–0.58) were associated with gallbladder diseases. Conclusions: We found that there were some factors associated with gallbladder disease, and there needs to be further studies to confirm these associations.

Comparison of coronary heart disease risk assessments among individuals with metabolic syndrome using three diagnostic definitions: a cross-sectional study from China

ObjectiveMetabolic syndrome (MetS) is a notable risk factor of coronary heart disease (CHD). However, there are differences in the methods used to define MetS. The purpose of this study was...

Prevalence of hypercholesterolemia and influence factors in residents aged 18-65 years in Beijing

Objective: To understand the prevalence of hypercholesterolemia and related risk factors in residents aged 18-65 years in Beijing and provide scientific evidence for the prevention and control of hypercholesterolemia. Methods: The data were collected from Beijing Non-communicable and Chronic Disease Survey and stratified cluster sampling method was used to select study subjects, and questionnaire investigation, physical measurement and laboratory examination were conducted to collect information. Results: The prevalence of hypercholesterolemia and borderline hypercholesterolemia was 6.26% and 21.34% respectively in 17 662 residents surveyed, the average total cholesterol level was (4.69±0.95) mmol/L. The prevalence of hypercholesterolemia was 6.33% in men and 6.20% in women, the difference was not significant (Z=1.64, P=0.10). The prevalence was higher inurban area than in suburb (6.73% vs. 5.59%; Z=-7.27, P<0.01). The prevalence of hypercholesterolemia increased with age (trend χ(2)=308.85, P<0.01). The trend was observed in men (trend χ(2)=81.65, P<0.01), in women (trend χ(2)=318.04, P<0.01), in urban area (trend χ(2)=201.77, P<0.01) and in suburb (trend χ(2)=114.65, P<0.01). Multiple logistic regression showed age, being female (OR=1.23, 95%CI: 1.04-1.45), overweight (OR=1.56, 95%CI: 1.34-1.81), obesity (OR=1.82, 95%CI: 1.54-2.16), smoking (OR=1.24, 95%CI: 1.03-1.50), alcohol use (OR=1.40, 95%CI: 1.12-1.75), beef and mutton intake >1 time per week (OR=1.19, 95%CI: 1.02-1.39) were risk factors. Conclusion: The prevalence of hypercholesterolemia in Beijing was lower than national level, and age, gender, location, BMI, smoking, alcohol use, beef and mutton intake were main influencing factors.

Expenditure in outpatient department and pharmacy on patients with hypertension and the influence from community health management program

To explore the impact of health management programs on hypertension related to their cost of the hypertensive, so as to provide evidence for related policy-making. Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps. Information regarding hypertensive patients were collected through a questionnaire. Two-part model was used to analyze the influence from health management scheme. This study included 11 294 participants who were 35 years old or beyond, with 4 904 (43.42%) males and 6 390 (56.58%) females. The median cost from the outpatient was 100 (30-200) Yuan, and the cost of patients under management program were significantly lower than those without (P<0.05). Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P>0.05). Regarding the calculation on the outpatient cost, results showed that the patients under the management program were more likely to practice 'outpatient-medical-behavior' (OR =2.50, 95% CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients. Hypertensive patients from the urban areas were more likely to adopt 'medical behavior'(OR=1.31, 95% CI:1.18-1.45) which was 1.69 times of the costs from the rural patients. RESULTS of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10, 95% CI:1.01-1.20) and was 1.19 times the costs of the rural patients. Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.

Identification of Risk Factors Affecting Impaired Fasting Glucose and Diabetes in Adult Patients from Northeast China.

Background: Besides genetic factors, the occurrence of diabetes is influenced by lifestyles and environmental factors as well as trace elements in diet materials. Subjects with impaired fasting glucose (IFG) have an increased risk of developing diabetes mellitus (DM). This study aimed to explore risk factors affecting IFG and diabetes in patients from Northeast China. Methods: A population-based, cross-sectional survey of chronic diseases and related risk factors was conducted in Jilin Province of Northeast China. All adult residents, aged 18–79, were invited to participate in this survey using the method of multistage stratified random cluster sampling. One hundred thirty-four patients with IFG or DM and 391 healthy control subjects were recruited. We compared demographic factors, body size measurements, healthy-related behaviors, and hair metallic element contents between IFG/diabetes patients and healthy individuals. Results: IFG/diabetes patients had a greater weight, waist, hip, and body mass index (BMI) than control subjects. Significant differences in the content of zinc (Zn), potassium (K), copper (Ca), and sodium (Na) as well as Cu/Zn ratios between IFG or DM patients and control subjects (p < 0.05) were also observed. Hair Cu, selenium (Se), and Na contents were positively correlated with blood glucose levels (Cu: rs = 0.135, p = 0.002; Se: rs = 0.110, p = 0.012; Na: rs = 0.091, p = 0.038). Polytomous logistic regression adjusting for age, sex, family history of diabetes and BMI, showed that subjects with high BMI were more likely to develop IFG and DM (IFG: OR = 1.15, OR 95% CI = 1.02–1.29; DM: OR = 1.15, OR 95% CI = 1.01–1.33). Moreover, rarely or never eating fruits was a risk factor for DM (OR = 5.46, OR 95% CI = 1.87–15.98) but not for IFG (OR = 1.70, OR 95% CI = 0.72–4.02). Subjects with abdominal obesity or DM history were more susceptible to DM (abdominal obesity: OR = 2.99, OR 95% CI = 1.07–8.37; DM history: OR = 2.69, OR 95% CI = 1.01–7.20). We found that subjects living in Changling County had a significantly lower chance to suffer from IFG (OR and 95% CI for OR: 0.25, 0.08–0.74). Men and 60–69 years old subjects were at increased risk for IFG (male: OR = 3.51, OR 95% CI = 1.34–9.18; age 60–69: OR = 6.64, OR 95% CI = 1.36–32.47). We did not find significant associations of IFG or DM with certain lifestyles (such as eating more meat, exercise or physical activity, smoking, or alcohol drinking) or the content of some metallic elements (such as iron (Fe), Zn , K, calcium (Ca), Na, or magnesium (Mg)). Conclusions: This study demonstrated that less or no fruit eating, DM family history, abdominal obesity conferred vulnerability to DM. Living in Changling County, men and 60–69 years old subjects were found to be risk factors for IFG. Subjects with high BMI were more likely to develop IFG and DM.

Rural-urban differences in the prevalence of chronic disease in northeast China.

Rural-urban differences in the prevalence of chronic diseases in the adult population of northeast China are examined. The Jilin Provincial Chronic Disease Survey used personal interviews and physical measures to research the presence of a range of chronic diseases among a large sample of rural and urban provincial residents aged 18 to 79 years (N = 21 435). Logistic regression analyses were used. After adjusting for age and gender, rural residents had higher prevalence of hypertension, chronic ischemic heart disease, cerebrovascular disease, chronic low back pain, arthritis, chronic gastroenteritis/peptic ulcer, chronic cholecystitis/gallstones, and chronic lower respiratory disease. Low education, low income, and smoking increased the risk of chronic diseases in rural areas. Reducing rural-urban differences in chronic disease presents a formidable public health challenge for China. The solution requires focusing attention on issues endemic to rural areas such as poverty, lack of chronic disease knowledge, and the inequality in access to primary care.

Mediation role of C-reactive protein on the association between smoking quantity and type 2 diabetes in current Chinese smokers.

Objective. Previous studies have indicated that cigarette smokers are more likely to develop type 2 diabetes and that both smoking and type 2 diabetes are associated with C-reactive protein (CRP). This study examined whether CRP mediates the association between smoking quantity and type 2 diabetes. Methods. Nine hundred and eighty-four current Chinese smokers were selected from a community-based chronic disease survey conducted in Guangzhou and Zhuhai. Type 2 diabetes was defined according to the WHO 1999 criteria. CRP was measured with flow cytometry. Binary logistic regression was performed to assess the mediation. Results. A positive association was observed between smoking quantity and type 2 diabetes (P < 0.05). After controlling for potential confounders, daily cigarette consumption was significantly associated with higher CRP levels. Current smokers with type 2 diabetes had higher CRP levels than smokers without type 2 diabetes. The association between the smoking quantity and type 2 diabetes was mediated by CRP, which accounted for 50.77% of the association. Conclusions. This study provides further evidence that smoking quantity is positively associated with type 2 diabetes and suggests that the association between smoking and type 2 diabetes might be mediated by CRP.

The association between smoking quantity and hypertension mediated by inflammation in Chinese current smokers

Previous studies indicated that cigarette smokers were more likely to develop hypertension, and both smoking and hypertension were associated with inflammation. Whether inflammation mediates the relationship of them is unclear. This study aims to examine whether inflammation mediates the association between smoking and hypertension. Nine hundred and eighty-four Chinese current smokers from a community-based chronic diseases survey in Guangzhou and Zhuhai were interviewed about sociodemographics, smoking, chronic conditions, and other health-related variables. Hypertension was defined according to 2007 European Society of Hypertension and European Society of Cardiology (ESH-ESC) Practice Guidelines. Inflammatory markers including C-reactive protein (CRP), interleukin (IL)-6, IL-1β, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α (TNF-α), and vascular cell adhesion molecule-1 (VCAM-1) were measured by flow cytometry. Logistic regressions were performed to assess the mediation of inflammation on the relationship between smoking quantity and hypertension. We observed a positive association between smoking quantity and hypertension (P<0.05). After controlling for potential confounders, daily cigarette consumption was significantly associated with higher level of CRP and VCAM-1 and lower level of TNF-α among six measured inflammatory markers, and the current smokers with hypertension had significantly higher level of MCP-1 and CRP than those smokers who were normotensive. Furthermore, the association between smoking quantity and hypertension was mediated by CRP, which accounted for 58.59% of the estimated causal effect of smoking on hypertension. We have confirmed previous observations that smoking quantity was positively associated with hypertension, and the results of our study suggested that the association between smoking and hypertension was probably mediated by CRP.