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BackgroundIn China, road traffic injury (RTI) is the seventh-leading cause of death More than 1.5 million adults in China live with permanent disabilities due to road traffic accidents. In 2011, the Chinese government implemented a more severe law that increased the penalty points and fines for persons charged with drink-driving as a criminal offence.ObjectivesThis study evaluated the short-term and long-term effects of the drink-driving law. It also aimed to establish whether punishments of increased severity resulted in greater reductions in RTI mortality.MethodsRTI mortality data was obtained from the Disease Surveillance Points System. A two-level interrupted time series model was used to analyse daily and monthly road traffic mortality rates, accounting for the varying trends among counties.ResultsThe overall RTI mortality rate showed a decreasing trend from 2007 to 2015 in mainland China, especially after 2011, and similarly decreasing trends were noted among males and females and in urban and rural areas. After the Criminal Law and Road Traffic Law amendment was implemented in 2011, charging drink-driving as a criminal offence, the immediate daily RTI mortality rate reduced by 1.57% (RR=0.9843, 95% CI: 0.9444 to 1.0259), while the slope change significantly decreased by 0.04% (RR=0.9996, 95% CI: 0.9994 to 0.9997) compared with the period before the Law was revised. Stratified analysis showed that the effect size of the law was higher for males in urban and high socioeconomic circumstances (SEC) than females in rural and low and moderate SEC. Meanwhile, the increase in penalty points for dangerous driving behaviours showed no significant effects.ConclusionEvidence was found that charging criminal responsibility for drink-driving is associated with reducing RTI deaths in China.

Stroke is characterised by high mortality and disability rate in China. This study aimed to explore the temporal trends in years of life lost (YLL) and loss of life expectancy due to stroke and its subtypes in urban and rural areas in China during 2005–2020. Data were obtained from China National Mortality Surveillance System. Abbreviated life and stroke-eliminated life tables were generated to calculate loss of life expectancy. The YLL and loss of life expectancy due to stroke in urban and rural areas at both national and provincial level during 2005–2020 were estimated. In China, the age-standardised YLL rate due to stroke and its subtypes were higher in rural areas than in urban areas. The YLL rate due to stroke showed a downward trend in both urban and rural residents from 2005 to 2020, decreased by 39.9% and 21.5%, respectively. Loss of life expectancy caused by stroke decreased from 1.75 years to 1.70 years from 2005 to 2020. During which, loss of life expectancy due to intracerebral haemorrhage (ICH) decreased from 0.94 years to 0.65 years, while that of ischaemic stroke (IS) increased from 0.62 years to 0.86 years. A slightly upward trend was observed in loss of life expectancy caused by subarachnoid haemorrhage (SAH), from 0.05 years to 0.06 years. Loss of life expectancy due to ICH and SAH was always higher in rural areas than in urban areas, whereas that of IS was higher in urban areas than in rural areas. Rural males suffered the greatest loss of life expectancy due to ICH and SAH, while the highest loss of life expectancy caused by IS was found in urban females. Furthermore, Heilongjiang (2.25 years), Tibet (2.17 years) and Jilin (2.16 years) were found to have the highest loss of life expectancy caused by stroke in 2020. Loss of life expectancy caused by ICH and SAH was higher in western China, while the disease burden of IS was heavier in northeast China. Stroke remains a major public health problem in China, although the age-standardised YLL rate and loss of life expectancy due to stroke decreased. Evidence-based strategies should be conducted to reduce the premature death burden caused by stroke and prolong life expectancy in Chinese population.

ObjectiveTo evaluate the trends in disease burden and the epidemiological features of central nervous system (CNS) cancer in China from 1990 to 2019.DesignA population-based observational study.SettingThe incidence, prevalence, death and disability-adjusted life years (DALYs) due to CNS cancer in China, stratified by sex, age and provincial region, were collected from the Global Burden of Disease Study 2019.ParticipantsData were publicly available and individuals were not involved.ResultsIn 2019, the incident cases of CNS cancer in China were 347 992 (95% UI 262 084–388 896), and the age-standardised rate (ASR) of incidence was 5.69 (95% UI 4.36–6.78) per 100 000 person-years increased by 27.9% compared with that in 1990; meanwhile, CNS cancer caused 63 527 (95% UI 47 793–76 948) deaths in China in 2019, and the ASR of death was 3.5 (95% UI 2.62–4.21) per 100 000 person-years decreased by 9.6%. The ASRs of incidence and prevalence of CNS cancer in China increased more rapidly than the global average; meanwhile, the ASRs of DALYs owing to CNS cancer declined more rapidly. The burden of CNS cancer showed no significant differences between men and women, but was more pronounced in early childhood and old adulthood. The ASRs of incidence and prevalence were higher in high-income provinces, confirmed by the positive correlation with Sociodemographic Index (SDI), with correlation coefficient r of 0.322 and 0.767, respectively (both pConclusionsFrom a global perspective, China has been bearing a substantial burden of CNS cancer. More attention should be paid to children and elderly populations for CNS cancer. The disease burden varied significantly at the subnational level of China, which was associated with socioeconomic development.

BackgroundUnderstanding disparities in the burden of cancer attributable to smoking is crucial to inform and improve tobacco control measures. In this report, we estimate the population attributable fraction (PAF) of cancers deaths attributable to smoking at the national and provincial levels in China.MethodsUsing cancer mortality data from 978 counties, smoking data from a nationwide survey and relative risks from a prospective study of 0.5 million adults in China, we calculated the absolute (non-standardised) and standardised numbers and proportions of cancer deaths among adults 30 years and older attributable to active and second-hand smoking in 2014 across all 31 provinces in Mainland China.ResultsThe estimated number of cancer deaths attributable to smoking in China in 2014 was 342 854 among men and 40 313 among women, of which second-hand smoking accounted for 1.8% and 50.0%, respectively. Among men, the absolute PAF in China was 23.8%, ranging from 14.6% in Xinjiang to 26.8% in Tianjin; the overall standardised PAF was 22.2%, ranging from 15.7% in Xinjiang to 26.0% in Guizhou. Among women, the overall absolute and standardised PAFs were 4.8% and 4.0%, ranging from 1.8% and 1.6% in Jiangxi to 14.9% and 9.6% in Heilongjiang, respectively. Overall, provinces with the highest standardised PAFs among men were located in Southwest China and among women in the Northeast.ConclusionsComprehensive smoke-free policies in China should expand to all provinces, notably those with a higher burden of cancer attributable to smoking, instead of being mostly limited to Beijing and some other metropolitan areas.

ObjectivesTo investigate potential geographical and socioeconomic patterning of allostatic load (AL) in China.DesignMultilevel longitudinal study of the 2010 Chronic Disease Risk Factor Surveillance linked to the National Death Surveillance up to 31 December 2015.SettingAll 31 provinces in China, not including Hong Kong, Macao or Taiwan.Participants96 466 ≥ 18 years old (women=54.3%).ExposuresPerson-level educational attainment and mean years of education in counties.OutcomeAL was measured using clinical guidelines for nine biomarkers: body mass index; waist circumference; systolic blood pressure; diastolic blood pressure; fasting blood glucose; total cholesterol; triglycerides; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol.ResultsMultilevel logistic regressions adjusted for sex, age, marital status, person-level education, county mean years of education and urban/rural reported ORs of 1.22 (95% CI 1.08 to 1.38) for 5-year all-cause mortality (n=3284) and 1.20 (1.04–1.37) for deaths from non-communicable diseases (n=2891) among people in AL quintile 5 (high) compared with quintile 1 (low). The median rate ratio estimated from unadjusted multilevel negative binomial regression showed AL clustered geographically (province=1.14; county=1.12; town=1.11; village=1.14). After adjusting for aforementioned confounders, AL remained higher with age (rate ratio 1.02, 95% CI 1.02 to 1.02), higher in women compared with men (1.17, 1.15 to 1.19), lower among singletons (0.83, 0.81 to 0.85) and widowers (0.96, 0.94 to 0.98). AL was lower among people with university-level compared with no education (0.92, 0.89 to 0.96), but higher in counties with higher mean education years (1.03, 1.01 to 1.05). A two-way interaction suggested AL was higher (1.04, 1.02 to 1.06) among those with university-level compared with no education within counties with higher mean years of education. Similar results were observed for alternative constructions of AL using 75th and 80th percentile cut-points.ConclusionsAL in China is patterned geographically. The degree of association between AL and person-level education seems to be dependent on area-level education, which may be a proxy for other contextual factors that warrant investigation.

Objectives To examine the association between temperature and cause specific mortality, and to quantify the corresponding disease burden attributable to non-optimum ambient temperatures. Design Time series analysis. Setting 272 main cities in China. Population Non-accidental deaths in 272 cities covered by the Disease Surveillance Point System of China, from January 2013 to December 2015. Main outcomes and measures Daily numbers of deaths from all non-accidental causes and main cardiorespiratory diseases. Potential effect modifiers included demographic, climatic, geographical, and socioeconomic characteristics. The analysis used distributed lag non-linear models to estimate city specific associations, and multivariate meta-regression analysis to obtain the effect estimates at national and regional levels. Results 1 826 186 non-accidental deaths from total causes were recorded in the study period. Temperature and mortality consistently showed inversely J shaped associations. At the national average level, relative to the minimum mortality temperature (22.8°C, 79.1st centile), the mortality risk of extreme cold temperature (at −1.4°C, the 2.5th centile) lasted for more than 14 days, whereas the risk of extreme hot temperature (at 29.0°C, the 97.5th centile) appeared immediately and lasted for two to three days. 14.33% of non-accidental total mortality was attributable to non-optimum temperatures, of which moderate cold (ranging from −1.4 to 22.8°C), moderate heat (22.8 to 29.0°C), extreme cold (−6.4 to −1.4°C), and extreme heat (29.0 to 31.6°C) temperatures corresponded to attributable fractions of 10.49%, 2.08%, 1.14%, and 0.63%, respectively. The attributable fractions were 17.48% for overall cardiovascular disease, 18.76% for coronary heart disease, 16.11% for overall stroke, 14.09% for ischaemic stroke, 18.10% for haemorrhagic stroke, 10.57% for overall respiratory disease, and 12.57% for chronic obstructive pulmonary diseases. The mortality risk and burden were more prominent in the temperate monsoon and subtropical monsoon climatic zones, in specific subgroups (female sex, age ≥75 years, and ≤9 years spent in education), and in cities characterised by higher urbanisations rates and shorter durations of central heating. Conclusions This nationwide study provides a comprehensive picture of the non-linear associations between ambient temperature and mortality from all natural causes and main cardiorespiratory diseases, as well as the corresponding disease burden that is mainly attributable to moderate cold temperatures in China. The findings on vulnerability characteristics can help improve clinical and public health practices to reduce disease burden associated with current and future abnormal weather.

Objectives To estimate the short term effect of particulate air pollution (particle diameter 10 ) on mortality and explore the heterogeneity of particulate air pollution effects in major cities in China. Design Generalised linear models with different lag structures using time series data. Setting 38 of the largest cities in 27 provinces of China (combined population >200 million). Participants 350 638 deaths (200 912 in males, 149 726 in females) recorded in 38 city districts by the Disease Surveillance Point System of the Chinese Center for Disease Control and Prevention from 1 January 2010 to 29 June 2013. Main outcome measure Daily numbers of deaths from all causes, cardiorespiratory diseases, and non-cardiorespiratory diseases and among different demographic groups were used to estimate the associations between particulate air pollution and mortality. Results A 10 µg/m 3 change in concurrent day PM 10 concentrations was associated with a 0.44% (95% confidence interval 0.30% to 0.58%) increase in daily number of deaths. Previous day and two day lagged PM 10 levels decreased in magnitude by one third and two thirds but remained statistically significantly associated with increased mortality. The estimate for the effect of PM 10 on deaths from cardiorespiratory diseases was 0.62% (0.43% to 0.81%) per 10 µg/m 3 compared with 0.26% (0.09% to 0.42%) for other cause mortality. Exposure to PM 10 had a greater impact on females than on males. Adults aged 60 and over were more vulnerable to particulate air pollution at high levels than those aged less than 60. The PM 10 effect varied across different cities and marginally decreased in cities with higher PM 10 concentrations. Conclusion Particulate air pollution has a greater impact on deaths from cardiorespiratory diseases than it does on other cause mortality. People aged 60 or more have a higher risk of death from particulate air pollution than people aged less than 60. The estimates of the effect varied across cities and covered a wide range of domain.

Objectives - To examine the modification of temperature-mortality association by factors at the individual and community levels. Design and methods - This study investigated this issue using a national database comprising daily data of 66 Chinese communities for 2006–2011. A ‘threshold-natural cubic spline’ distributed lag non-linear model was utilised to estimate the mortality effects of daily mean temperature, and then examined the modification of the relationship by individual factors (age, sex, education level, place of death and cause of death) using a meta-analysis approach and community-level factors (annual temperature, population density, sex ratio, percentage of older population, health access, household income and latitude) using a meta-regression method. Results - We found significant effects of high and low temperatures on mortality in China. The pooled excess mortality risk was 1.04% (95% CI 0.90% to 1.18%) for a 1°C temperature decrease below the minimum mortality temperature (MMT), and 3.44% (95% CI 3.00% to 3.88%) for a 1°C temperature increase above MMT. At the individual level, age and place of death were found to be significant modifiers of cold effect, while age, sex, place of death, cause of death and education level were effect modifiers of heat effect. At the community level, communities with lower socioeconomic status and higher annual temperature were generally more vulnerable to the mortality effects of high and low temperatures. Conclusions - This study identifies susceptibility based on both individual-level and community-level effect modifiers; more attention should be given to these vulnerable individuals and communities to reduce adverse health effects of extreme temperatures.

Background Rapid economic transition has been cited as a driving force behind China’s escalating obesity epidemic. Yet it is unclear whether obesity remains a so-called ‘ disease of affluence ’ or if trends are converging towards the negative socio-economic gradient more commonly observed (e.g. in the US). The purpose of this study was to examine the association between body mass index (BMI) and socio-economic circumstances (SEC) measured for individuals and the areas in which they lived. Methods BMI was derived from objectively-measured height and weight for 16,065 adults aged 18 and older in the China Chronic Disease Risk Factor Survey in 2010. Individual-level SEC was measured by the highest educational qualification achieved by each participant (none, primary school, secondary school, university). Area-level SEC was measured using the mean years of education accumulated among residents of each county. Single and multilevel linear regression were used to disentangle the influence of area-level SEC from individual-level SEC on BMI, adjusting for potential mediators (dietary factors and physical activity) and sources of confounding (age, gender, urbanisation and region). Results The mean BMI was approximately 24 (the lower threshold of ‘overweight’, by Chinese standards). A single-level model indicated positive association between BMI and individual-level SEC (e.g. university coefficient 0.28, 95% CI 0.07, 0.49). Fitting random intercepts, however, revealed approximately 10.6% of the variation in BMI could be attributed to geographical factors. This switch to a multilevel model also resulted in the inversion of the previously observed association between BMI and individual-level SEC (e.g. university coefficient -0.30, 95% CI -0.53, -0.08). Adjustment for area-level SEC demonstrated as positive association between BMI and the mean years of education in a county (coefficient 0.29, 95% CI 0.21, 0.37). An interaction term showed participants with low SEC and living in a high SEC county (i.e. relatively deprived) had a higher BMI than other low-SEC persons living in a lower SEC county (i.e. contextually similar). In contrast, participants with higher individual-level SEC appeared to be uninfluenced by the SEC of their surroundings. These patterns of BMI by area- and individual-level SEC were robust to adjustment for mediators and confounders. Conclusion The association between BMI and individual-level SEC in China is modified by the SEC of where people live. Future work on obesity in China needs to consider psychosocial mechanisms (e.g. relative deprivation) as well as materialistic pathways. People with low SEC, living in higher SEC counties, should be targeted for obesity prevention interventions.

Background The 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 people, a roughly 6% of Chinese population. To estimate the completeness of DSPs data, an independent household investigation of missing were conducted in 2009. Aims/Objectives/Purpose To adjust the underreporting of injury death data in DSPs system. Methods This paper proposes and compares two methods to correct for underreporting of injury deaths. First a cell-based weighting system is applied whereby underreporting rates for 18 cells defined by 3 age groups×2 sexes×3 regions were computed using the household survey as a gold standard. The second method is a propensity weighting method based on a logistic regression of underreport against age, sex, region, season, education, occupation, place of death and cause of death. Results/Outcome The results from both adjustment methods performed better than the original DSPs data, compared with estimates from other sources such as WHO. The Life Expectancy at age 5 is 72.1 years in unadjusted data while compartment method and propensity weighting method respectively give 70.0 and 69.8, much closer to WHO estimate 70.3. Significance/Contribution to the Field The adjusted DSPs data could provide valuable information for evidence-based injury-related policy-making in China. Additionally, the two approaches compared here can be applicable for other developing countries that also suffer underreporting problems.

Background The police-reported recent decrease in pedestrian fatality was questionable in terms of the serious under-reporting of police-reported data. Aims/Objectives/Purpose To examine changes in pedestrian fatality between 2006 and 2010 in China using Non-police-reported data. Methods A longitudinal study was conducted based on the mortality data during 2006-2010 from the Disease Surveillance Points data of China. Multivariate Poisson regression was used to control the effects of sex, age, and urban/rural. Mortality rate ratio (MRR) was used to quantify the increase in pedestrian fatality. 'p Results/Outcomes Between 2006 and 2010, the crude pedestrian fatality increased from 7.0 to 10.5 per 100 000 population. After controlling sex, age and urban/rural, the fatality increased by 44% in the research time period (adjusted MRR=1.11, 95% CI 1.10 to 1.11). Males had higher fatality rate than females (adjusted MRR=2.54, 95% CI 2.48 to 2.61); rural residents were 1.42 times urban residents dying as pedestrians (adjusted MRR=1.42, 95% CI 1.39 to 1.45). Selecting children less than 5 years as the reference, persons ages 5-14 years, 15-24 years, 25-59 years, and 60+ ages had the MRRs as 0.64, 1.42, 2.56, 5.52, respectively. Significance/Contribution to the Field The recent police-reported decrease in pedestrian fatality may not be true. Non-police-reported data should be applied to improve the quality of pedestrian injury data in China. The high-risk groups of pedestrian fatality--men, rural residents, old age groups, should be addressed in China's injury prevention action. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.