Years Of Age In China Research Articles

Reducing Indoor Levels of "Outdoor PM2.5" in Urban China: Impact on Mortalities.

This study estimates adult mortalities attributed to PM2.5 across urban China in 2015 and the corresponding mortalities that might be avoided by meeting the yearly averaged indoor PM2.5 threshold in the newly established Assessment Standard for Healthy Building (ASHB) and seven other potential thresholds. We use outdoor PM2.5 concentrations from ∼1500 monitoring sites in 339 Chinese cities, coupled with a detailed exposure model, to estimate outdoor and indoor exposures to PM2.5 originating outdoors. We proceed to calculate premature mortality attributable to PM2.5 exposure using an integrated exposure-response model. Results indicate that indoor exposures accounted for 66%-87% of total exposure to PM2.5 of outdoor origin and 81% (95% confidence interval (CI), 71%-87%), i.e., 316 000 (95% CI, 176 000-435 000), of the 389 000 (95% CI, 245 000-501 000) mortalities attributable to "outdoor PM2.5" for the urban population ≥25 years of age in China in 2015. Potentially 14 000 (95% CI, 8000-20 000) deaths might be avoided if indoor PM2.5 of outdoor origin met the ASHB guideline of 35 μg/m3 for annual mean indoor PM2.5, and 162 000 (95% CI, 79 000-237 000) deaths might be avoided by meeting a 10 μg/m3 threshold. The analysis in this work should be helpful in formulating indoor air quality policies.

Characteristics and outcome of impacted button batteries among young children less than 7years of age in China: a retrospective analysis of 116 cases.

Ingestion of button batteries occurs in about ten persons per one million persons each year, with most of them children, and one in every 1000 battery ingestions leads to serious injuries. This study aimed to describe the clinical features and outcome of ingestion or inhalation of button batteries in children spanning a decade from January, 2006 to December, 2016 at a tertiary care hospital. We reviewed the clinical records of children who sought treatment for inhaled or ingested button batteries at our hospital during the study period. Data on gender, age, time from ingestion to treatment, site of impaction, imaging findings, and outcomes were retrieved and analyzed. We identified 116 pediatric cases of ingestion or inhalation of button batteries. Their mean age was 26months. The time from ingestion or inhalation of button batteries to treatment was 0.5hours to 2weeks. Ninety-seven (83.6%) button batteries were located in the nasal cavity, 13 (11.2%) in the gastrointestinal (GI) tract including 6 in the esophagus, and 7 in the stomach and lower GI tract, and 6 (5.2%) in the auditory tract. Twenty-one (21.6%) children with nasal button batteries had preoperative septal perforations and one (1.0%) had postoperative septal perforation. One child with esophageal button battery developed esophageal stricture and one died of sudden cardiac arrest perioperatively. One child had auditory damages in the right tympanic membrane and ossicles. Inhalation or ingestion may occur in the nasal cavities, the esophagus and GI tract and the auditory tract. Prompt diagnosis and treatment are required for a satisfactory outcome and ingested or inhaled button batteries require different treatment protocols.

Tightening Standards for Indoor Levels of PM2.5: A Promising Approach for Reducing PM2.5 Associated Mortalities in Urban China

Outdoor PM2.5 pollution in China has been estimated to cause more than one million premature mortalities annually. In urban areas residents spend a major fraction of their time indoors, meaning that a large fraction of urban exposure to “outdoor PM2.5” occurs indoors. This study estimates premature adult mortalities attributed to PM2.5 across urban China in 2015 and the corresponding mortality reductions achieved by meeting the yearly-averaged indoor PM2.5 threshold in the newly established Assessment Standard for Healthy Building (ASHB) and seven other potential thresholds. We use outdoor PM2.5 concentrations from 1497 monitoring sites in 366 cities in China, coupled with a detailed exposure model, to estimate outdoor and indoor exposures to PM2.5 originating outdoors. We proceed to calculate premature mortality attributable to PM2.5 exposure using an integrated exposure-response model. Results indicate that indoor exposures accounted for 66%-87% of total exposure to PM2.5 of outdoor origin and 76% (248,174) of the 328,362 premature mortalities attributable to “outdoor PM2.5” for the urban population ≥25 years of age in China in 2015. Stroke, ischemic heart disease, chronic obstructive pulmonary disease, and lung cancer mortalities attributable to indoor exposure were 132,209, 71,960, 24,233 and 19,773, respectively. Potentially 10,172 deaths could be avoided if indoor PM2.5 of outdoor origin met the current ASHB standard of 35 μg/m3 as annual mean, and 113,219 deaths could be avoided by meeting a 10 μg/m3 threshold. The findings demonstrate the effectiveness of reducing indoor exposures to “outdoor PM2.5” in reducing premature mortalities attributable to urban PM2.5 pollution in China. Estimates of mortality reductions associated with various indoor PM2.5 thresholds can help formulate indoor air quality policies and practices, including building- or room-based filtration of ventilation air.

Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry: protocol for a prospective, observational nationwide cohort study

IntroductionAtrial fibrillation (AF) is a worldwide healthcare burden that is associated with the ageing population. Elderly patients with AF with multiple comorbidities usually present with a high risk of thromboembolism...

Norovirus, the Next Target for Vaccine Development in China

<p>Enteric virus-induced disease, even death, greatly affects the life quality of children <5 years of age in China, and imposes a heavy sociometric burden on family and government. The infectious diarrhea diseases and hand-foot-mouth disease (HFMD) have been enrolled in the list of notifiable infectious diseases in China. Fortunately, the highly valued rotavirus-induced diarrhea and enterovirus 71-induced HFMD can be prevented by the commercial vaccines. However, the underrated norovirus vaccine is still in progress, even norovirus was considered as the leading cause of acute gastroenteritis in children <5 years of age in the world, partially due to the inability to cultivate norovirus. Besides, the broad genetic and serotypic diversity of norovirus also complicates selection of candidate vaccine strain(s). Therefore, the primary objective of this article is to review norovirus epidemics in China recur to the data published in recent five years.</p>

A hearing self-reported survey in people over 80 years of age in China by hearing handicap inventory for the elderly–complete version vs screening version

Conclusion: HHIE-S can be a useful tool in investigating hearing loss among people over 80 years old, with the same validity as HHIE. Objective: To investigate the effect of hearing loss on the quality-of-life in people over 80 years of age in China, and to compare the results of the Chinese mandarin version Hearing Handicap Inventory for the Elderly (HHIE) and its screening version (HHIE-S). Methods: Eighty-four people over 80 years participated in the study. Both HHIE and HHIE-S were completed, and the hearing handicap degrees were rated according to HHIE scores and HHIE-S scores, respectively. Results obtained by HHIE and HHIE-S were compared. Multi-factor analysis of variance was used to analyze the impact of eight factors on hearing handicap in the oldest old people over 80 years of age, including age, noise exposure, ear surgery, infection, ototoxic drugs use, cardiovascular and cerebrovascular diseases, diabetes, and tumors. Results: Both HHIE and HHIE-S revealed 48 subjects (57.1%) with no self-perceived hearing problem, and 36 subjects (42.9%) with hearing handicap. No statistical difference was found between results of the functional hearing handicap rating by HHIE and HHIE-S (Chi-square = 1.532, p = 0.465). The HHIE and HHIE-S were in agreement with each other (kappa = 0.772, p < 0.001). All the eight factors had no significance on both HHIE and HHIE-S scores (p > 0.05), except noise exposure on S-score of HHIE-S (p = 0.032), and the R-squares of these factors were less than 5%.

Multi-center study on the effects of television viewing on sleep quality among children under 4 years of age in China

To explore the current television viewing situation among children less than 4 years of age in our country and investigate effects of television viewing on sleep quality. According to the"Hospital of Province-City-County"sampling technical route, a total of 1 046 full term healthy children at the age of 4-48 months were sampled by stratified cluster random sampling method from 8 provinces in China from 2012-2013. The information of television viewing and family and personal information was investigated by Shanghai Children's Medical Center Socio-demographic Questionnaire. Brief Infant Sleep Questionnaire (BISQ) and Brief Child Sleep Questionnaire (BCSQ) were employed to assess the sleep behaviors of children 0-3 years old and over 3 years old respectively.The effects of television viewing on sleep quality were analyzed by multiple linear regression analysis. The children's average age was (20±13) months, with boys accounted for 53.3% (558/1 046). The percentage of children who viewed television was 70.3% (735/1 046). Moreover, 58.7% (408/695) of infants and young children under the age of 2 viewed TV per day, and 19.9% (70/351) of 2 years and older infants and young children viewed television ≥2 hours per day. With the increase of age, the percentage of children who viewed television time gradually increased (P<0.001). Child sex, geographic area, paternal education, and family structure were not associated with television viewing time among children aged 4-48 months. However, the presence of a bedroom TV(χ(2)=13.682, P=0.001) and maternal employment (χ(2)=15.053, P=0.005) were commonly correlated with long screen-watching time among children. After adjusting for age, gender, mother' education level, and working state, it was revealed by multiple linear regression analysis that television viewing was not only positively correlated with later bedtime (t=5.49, P<0.001) and shorter night sleep duration (t=-3.49, P=0.001) but also significantly associated with longer sleep onset latency (t=2.63, P=0.009). The percentage of children under 4 years of age who viewed television is very high in our country, and many infants under 6 months of age exposed to TV environment. Bedroom TV and mother full-time job were associated with higher proportion of children viewing TV. In early childhood, television viewing was positively correlated with later bedtime, shorter sleep duration and longer sleep onset latency. There is a need for parents and pediatricians to pay more attention to the behavior of children viewing TV and improve sleep quality.

Rotavirus-specific and Overall Diarrhea Mortality in Chinese Children Younger than 5 Years: 2003 to 2012.

During the past decade, substantial declines in overall childhood mortality from diarrhea have been documented among Chinese children, but the last detailed assessment of rotavirus-specific mortality in China was conducted in 2002. To provide policy makers with up-to-date information, we examined rotavirus-related mortality in children <5 years of age in China during 2003-2012. We obtained mortality rates for children <5 years of age from the Chinese Health Statistic Yearbook; these figures were multiplied by the proportion of deaths in this age group attributable to diarrhea from the Chinese Maternal and Child Mortality Surveillance to obtain estimates of diarrhea deaths in children <5 years of age. To estimate rotavirus deaths, diarrhea death estimates were multiplied by the detection rate of rotavirus in children hospitalized with diarrhea from the Viral Diarrhea Surveillance System in China and from peer-reviewed literature. From 2003 to 2012, a total of 127,539 deaths from diarrhea were reported among Chinese children <5 years of age, of which an estimated 53,559 (42%) had illness attributable to rotavirus. Comparing 2003 to 2012, the annual number of deaths from rotavirus diarrhea decreased by 74% (from 10,531 to 2,791, respectively) and the mortality rate fell 74% (from 0.66 to 0.17 deaths per 1000 live births, respectively). Ninety-three percent of all rotavirus deaths occurred in rural areas, where mortality rates (0.33 deaths per 1000 live births in 2012) were 11 times greater than in urban areas (0.03 deaths per 1000 live births in 2012). Rotavirus diarrhea mortality has substantially declined in the past decade in Chinese children. The vast majority of rotavirus deaths occurred in rural areas. There is potential value in using rotavirus vaccine interventions in rural areas to further reduce mortality from this disease.

Assessment of chlorpyrifos exposure and absorbed daily doses among infants living in an agricultural area of the Province of Jiangsu, China

Chlorpyrifos (CPF) is one of the most widely used organophosphorous pesticides in China. However, few reports on CPF pesticide exposure and body burden of infants at 2years of age in China are available. The aim of this study was to assess the exposure level and the absorbed daily dose (ADD) of CPF among infants from an agricultural area of Jiangsu, China, and determine whether the infants' estimated dose exceeds the recommended reference dose (RfD) and the population adjusted dose (PAD) set by U.S. Environmental Protection Agency (EPA). In our study, 364 infants at 2years of age who lived in the agricultural area of Jiangsu Province (China) were enrolled into the biomonitoring study from June 2011 to January 2012. CPF exposure was estimated based on both questionnaire survey and measured results of urinary metabolite 3,5,6-trichloro-2-pyridinol (TCPy) of CPF by high-performance liquid chromatography. Furthermore, the ADD of CPF among infants was also evaluated and compared with the RfD and the PAD values issued by EPA. Urinary TCPy was detected in more than 70% of the urine samples among 364 infants. The unadjusted and creatinine-adjusted geometric means in these subjects for TCPy were 1.33μg/L and 6.73μg/g Cre., respectively. Infants lived nearby (100m distance) plantations or green parks present significantly higher levels of urinary TCPy than those lived far away (p=0.045). Urinary TCPy levels were also significantly higher in infants who had frequent hand-to-mouth activities than those with less frequency (p=0.037). Urinary TCPy concentrations in the infants at 2years of age in Jiangsu were lower than those in the children at 2-6years of age in the USA. The median estimated ADD of CPF in this study (0.07μg/kg/day) was much lower than the acute and chronic RfDs (5 and 0.3μg/kg/day, respectively) announced by EPA, but higher than the chronic PAD (cPAD) (0.03μg/kg/day) for children. Additionally, the 75th percentile of the estimated ADD in our study was 2.5 times as much as the cPAD from EPA, even assuming only half of the TCPy amount from CPF exposure. Our findings revealed that infants at 2years of age in Jiangsu of China were widely exposed to CPF pesticide. The estimated ADD probably suggested that about 25% of the enrolled infants were at potential risk of pesticide exposure, which warned of urgency to eliminate the potential exposure risk to infants living in agricultural areas of China.

An expanded age range for meningococcal meningitis: molecular diagnostic evidence from population-based surveillance in Asia

BackgroundTo understand epidemiologic patterns of meningococcal disease in Asia, we performed a retrospective molecular analysis of cerebrospinal fluid (CSF) specimens collected in prospective surveillance among children aged < 5 years of age in China, South Korea, and Vietnam.MethodsA total of 295 isolates and 2,302 CSFs were tested by a meningococcal species- and serogroup-specific polymerase chain reaction (PCR) assay targeting the Neisseria meningitidis (Nm) ctrA gene. Multi-locus sequence typing (MLST) was performed in Nm gene amplification analysis and incidence rates for meningococcal meningitis were estimated.ResultsAmong 295 isolates tested, 10 specimens from Vietnam were confirmed as serogroup B and all were Sequence Type (ST) 1576 by MLST. Among the 2,032 CSF specimen tested, 284 (14%) were confirmed by PCR (ctrA gene), including 67 (23.6%) from China, 92 (32.4%) from Korea, and 125 (44.0%) from Vietnam. Neonates and infants aged < 6 months of age accounted for more than 50% of Nm-PCR positive CSF. Two CSF specimens from Vietnam were identified as serogroup B using MLST. In addition, 44 specimens underwent sequencing to confirm meningococcal serogroup; of these, 21 (48%) were serogroup C, 12 (27%) were serogroup X, 9 (20%) were serogroup Y and 2 (5%) were serogroup B. The incidence rates of meningococcal meningitis among children < 5 years of age was highest in Vietnam (7.4/100,000 [95% CI, 3.6—15.3] followed by Korea (6.8/100,000 [95% CI, 3.5-13.5] and China (2.1/100,000) [95% CI, 0.7-6.2]).ConclusionsThese results suggest that there is a previously undetected, yet substantial burden of meningococcal meningitis among infants and young children. Standardized, sensitive and specific molecular diagnostic assays with Nm serogrouping capacity are needed throughout Asia to understand the true burden of N. meningitidis disease.

Nationwide study of injury‐related deaths among children aged 1–4 years in China, 2000–2008

The aims of this study are to investigate injury mortality in children aged 1-4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008. The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1-4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008. During the 9-year study period, the injury mortality rates for children aged 1-4 years declined significantly by an average of 5.4% each year (P < 0.001; 95% confidence interval (CI): 3.6-7.0%) overall in China, with a decrease of 4.8% (P < 0.001; 95% CI: 2.5-7.1%) and 9.9% (P < 0.001; 95% CI: 4.9-14.7%) in rural and urban areas, respectively. The proportion of injury-related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year (P < 0.001; 95% CI: 2.6-8.0%) and 6.1% (P < 0.001; 95% CI: 2.7-9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury-related deaths in children aged 1-4 years. Childhood injury is still the leading cause of death in children aged 1-4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury.

Projected health impact and cost-effectiveness of rotavirus vaccination among children

IntroductionTwo rotavirus vaccines have been licensed globally since 2006. In China, only a lamb rotavirus vaccine is licensed and several new rotavirus vaccines are in development. Data regarding the projected health impact and cost-effectiveness of vaccination of children in China against rotavirus will assist policy makers in developing recommendations for vaccination. MethodsUsing a Microsoft Excel model, we compared the national health and economic burden of rotavirus disease in China with and without a vaccination program. Model inputs included 2007 data on burden and cost of rotavirus outcomes (deaths, hospitalizations, outpatient visits), projected vaccine efficacy, coverage, and cost. Cost-effectiveness was measured in US dollars per disability-adjusted life-year (DALY) and US dollars per life saved. ResultsA 2-dose rotavirus vaccination program could annually avert 3013 (62%) deaths, 194,794 (59%) hospitalizations and 1,333,356 (51%) outpatient visits associated with rotavirus disease in China. The medical break-even price of the vaccine is $1.19 per dose. From a societal perspective, a vaccination program would be highly cost-effective in China at the vaccine price of $2.50 to $5 per dose, and be cost-effective at the price of $10 to $20 per dose. ConclusionsA national rotavirus vaccination program could be a cost-effective measure to effectively reduce deaths, hospitalizations, and outpatient visits due to rotavirus disease in China.

Mortality rate for children under 5 years of age in China from 1996 to 2006

To study the change in mortality rate for children under 5 years of age in China over the past decade, and to evaluate China's progress in achieving Millennium Development Goal 4. Population-based descriptive study. A population-based survey was conducted through a nationwide multi-level surveillance network. The mortality rate and the leading causes of death for children under 5 years of age were analysed. The mortality rate for children under 5 years of age in China dropped by 54.2% between 1996 and 2006 (from 45.0 per 1000 livebirths to 20.6). During this period, deaths due to pneumonia and diarrhoea dropped by 69.4% and 69.7%, respectively. The proportion of deaths due to pneumonia dropped from 23.4% in 1996 to 15.6% in 2006, and the proportion of deaths due to diarrhoea dropped from 5.6% in 1996 to 3.7% in 2006. The mortality rate for children under 5 years of age in China dropped remarkably from 1996 to 2006. This reduction was mainly due to a significant decrease in deaths due to pneumonia and diarrhoea. Based on the survey results, China should be able to achieve Millennium Development Goal 4.

Sexually Transmitted Infections Among Individuals Over Fifty Years of Age in China

Sexually Transmitted Infections Among Individuals Over Fifty Years of Age in China

Access to farming pesticides and risk for suicide in Chinese rural young people

Suicide is a leading cause of death in individuals 15–34 years of age in China. Highly lethal pesticides are a common method used for suicide in Chinese rural areas. This case-control study aimed to test hypotheses concerning the suicide risks associated with pesticide access. Subjects included 370 rural completed suicides aged 15–34 years and 370 living controls matched on age, gender and residence (rural/urban location). Data were collected by a psychological autopsy design with proxy respondents. Pesticide access was a significant risk factor for suicide even after controlling for other known risk factors in social and psychiatric domains, such as education level, living situation, marital status, family annual income and mental disorder. Increased risk was accounted for by access to insecticide rather than other types of pesticides. Suicide intervention in China should focus on restricting access to pesticides, especially highly toxic insecticide, improving the resuscitation skills of rural primary-care health providers, promoting psychological and social support networks in rural areas and educating the general public about the suicide risk of having pesticides stored at the households.

Molecular epidemiology of rotavirus among children under 5 years old hospitalized for diarrhea in China

To study molecular epidemiology of Rotavirus among children under 5 years of age in china. Stool specimens were collected from 4047 inpatients under 5 years of age with diarrhea in our 9 hospital-based surveillance sites from January 2006 to December 2007 following the WHO Rotavirus surveillance protocol. Rotavirus were detected by ELISA, Further strain characterization of rotavirus was carried out with RT-PCR. A total of 4047 stool samples were collected and 3862 of total stools were tested among which 1700 was positive. The Rotavirus positive rate is 44.0%. A peak admission of rotavirus diarrhea was observed from November to next January. More than 95.4% of viral diarrhea patients occurred in their first 2 years. The incidence rates of rotavirus diarrhea were highest in 12-17 months of age. The most common rotavirus strain was P[8]G3(58.3%); followed by P[8] G1(22.1%), P[4]G1 (3.0%), P[8]G9 (2.4%). G4 was not detected in this study. The four common strains were 80.8% in the world. Rotavirus diarrhea was an important infectious disease among children under 5 years of age in China. Safe and effective rotavirus vaccines for the prevention of rotavirus diarrhea and reduction of treatment costs are of significant importance to China.

Knowledge, attitude, practice and related determinants on nutrition among caregivers of rural stranded children under 7-year-olds in China

To explore knowledge, attitude, practice (KAP) and related determinants on nutrition among caregivers of those rural stranded children under 7 years of age in China and to provide evidence for setting up relevant health education program. 1691 caregivers of the stranded children randomly selected were surveyed by a standard questionnaire. Logistic regression models were used to screen the determinants on KAP regarding nutrition. Rates on awareness, positive attitude and approprite behavior were lower in caregivers of children whose parents both left (47.8%, 55.4%, 41.8%, respectively) the countryside, when compared with those only one parent was away from home (59.9%, 59.5%, 38.0%, respectively). Data from multivariable logistic regression models showed that caregivers' KAP on nutrition was related to age, educational background, average family income, and willingness on the job as well as the age of the child. Improving caregivers' KAP on nutrition and setting up appropriate health education program were in urgent need.

Suicide among the elderly in mainland China

Suicide in mainland China shows unique demographic patterns with age: the over-65 age group has the highest rate of completed suicide, reaching 44.3-200 per 100,000, which is four to five times higher than the Chinese general population. Rural suicide rates among the elderly are three to five times higher than the urban rates. The gender ratio of suicide in the elderly shows a reversal to those younger than 60 years of age in China. In addition, suicide methods and causes are different from those in Western countries. In the present paper, the profile of suicide among the elderly in China is delineated, including the prevalence, characteristics, underlying reasons and measures of preventing it.

Emergence of the GII4/2006b variant and recombinant noroviruses in China

Noroviruses are an important cause of acute gastroenteritis. Increasing data showed that the GII-4 strains are predominant worldwide and new GII-4 variants emerge every 1-2 years causing major epidemics. Surveillance of gastroenteritis in hospitalized children under 5 years of age in China is described. Among 1,110 specimens, 114 (10.3%) were positive for noroviruses, which was higher than adenoviruses (7.6%), astroviruses (3.5%), and sapoviruses (0.9%) and only lower than group A rotaviruses (40.6%). Thirty-eight of the 114 positive norovirus cases were co-infected with other enteric viruses. Five norovirus genotypes (GI-2, GI-4, GII-3, GII-4, and GII-14) were detected, with GII-4/2006b the most predominant type (64.9%). The reported recombinant of GII-3 capsid and GII-4 polymerase described previously was also detected frequently and a recombinant of GII-14 capsid and GII-6 polymerase was found for the first time. This study suggests that continual surveillance focusing on strain variation and dynamic change is important for understanding the epidemiology and development of a strategy for disease control and prevention.

Blood Pressure and Risk of Cardiovascular Disease in Chinese Men and Women

We examined the relationship between systolic and diastolic blood pressure (BP) and the incidence of cardiovascular disease (CVD) in a nationally representative cohort of 169,871 men and women > or = 40 years of age in China. Data on BP and other variables were obtained at a baseline examination in 1991 using standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, body mass index, education, geographic region, urbanization, and time-dependent history of diabetes, a strong and linear association between both systolic and diastolic BP and incidence of CVD, coronary heart disease and stroke were observed (all P < 0.0001). For example, the relative risks (95% confidence interval (CI)) of CVD incidence were 1.09 (1.00-1.18), 1.25 (1.16-1.35), 1.49 (1.38-1.62), 2.15 (1.99-2.31), 3.01 (2.78-3.27), and 4.16 (3.84-4.51) for those with systolic/diastolic BP of 110-119/75-79, 120-129/80-84, 130-139/85-89, 140-159/90-99, 160-179/100-109, and > or = 180/110 mm Hg compared to those with BP <110/75 mm Hg. Increases in systolic BP were associated with a greater risk of CVD compared to corresponding increases in diastolic BP. The linear trend for increased CVD risk being related to higher BP levels was observed in all subgroups of gender, age, body weight, and cigarette smoking. Our results indicate that there is a strong, linear, and independent relationship between BP levels and the risk of CVD in Chinese adults. Systolic BP is a stronger predictor of CVD risk compared to diastolic BP.