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Temporal trends and geographical variations in cardiovascular disease attributable to high systolic blood pressure in China are not yet fully understood. The aim of this study was to quantify the cardiovascular disease burden attributable to high systolic blood pressure at national and provincial levels in China.In this population-based study, we evaluated systolic blood pressure and estimated the number of deaths, age-standardised mortality rates, and years of life lost (YLLs) due to cardiovascular disease and its subcategories (including ischaemic heart disease, ischaemic stroke, haemorrhagic stroke, and other cardiovascular diseases) attributable to high systolic blood pressure, at the national level and by 31 provincial levels, in China, from 2005 to 2018. We pooled blood pressure data of 1·30 million adults aged 25 years and older from the China Chronic Disease and Risk Factor Surveillance project, the China National Nutrition Survey, and the China Hypertension Survey. We applied a temporal-spatial Bayesian hierarchical model to estimate age-specific, sex-specific, province-specific, and year-specific average systolic blood pressure, and a comparative risk assessment method to compute the cardiovascular disease burden attributable to high systolic blood pressure by age, sex, year, and province.Nationally, age-standardised mean systolic blood pressure was 132·5 mm Hg (95% uncertainty interval [UI] 124·6-140·3) in men and 129·4 mm Hg (121·7 to 137·2) in women. 2·67 million (95% UI 2·61 to 2·72) cardiovascular disease deaths in China were attributable to high systolic blood pressure, including 1·12 million deaths (1·07 to 1·16) due to ischaemic heart disease, 0·63 million deaths (0·60 to 0·65) due to ischaemic stroke, 0·58 million deaths (0·57 to 0·60) due to haemorrhagic stroke, and 0·34 million deaths (0·32 to 0·36) due to other cardiovascular disease. The age-standardised cardiovascular disease mortality rates associated with high systolic blood pressure were 268·99 per 100 000 people (95% UI 264·11 to 273·51) in 2005 and 220·84 per 100 000 people (216·30 to 224·76) in 2018, a percentage change of -17·90%; the rate changed by an average of -1·50% (95% UI -1·55% to -1·45%) per year from 2005 to 2018 nationally. YLL rates for total cardiovascular disease caused by high systolic blood pressure varied substantially across provinces, ranging from 3078·33 (95% UI 2807·40 to 3303·57) per 100 000 people in Beijing to 7189·98 (95% UI 6817·18 to 7507·99) per 100 000 people in Heilongjiang in 2018. Age-standardised YLL rates for ischaemic heart disease and ischaemic stroke attributable to high systolic blood pressure were particularly high in northeastern provinces, including Heilongjiang, Liaoning, and Jilin.The deaths and YLLs for cardiovascular disease attributable to high systolic blood pressure in China increased between 2005 and 2018, and age-standardised cardiovascular disease mortality rates decreased in the same timeframe. Our findings could help policy makers in promoting blood pressure control measures and implementing effective and locally adapted preventive interventions to reduce the prevalence of high systolic blood pressure and reduce the burden of systolic blood pressure-related cardiovascular disease in China.China National Key Research and Development Program, China National ScienceTechnology Pillar Program, and National Health Commission of the People's Republic of China.For the Chinese translation of the abstract see Supplementary Materials section.

Background To analysis the death and disease burden caused by high sugar-sweetened beverages intake in China from 1990 to 2019. Methods Data were obtained from the 2019 Global Burden of Disease Study. We analyzed the death cases caused by high sugar-sweetened beverages intake in China and provinces from 1990 to 2019, as well as the disease burden (including disability-adjusted of life year), years of life lost and years lived with disability, and compared the changes of death in 1990 and 2019. Results In 2019, the number of deaths attributed to sugar-sweetened beverages in China reached 46 633 with an increase of 95% compared with 1990. The proportion of deaths caused by excessive consumption of carbon-containing beverages increased from 0.34% in 1990 to 0.46% in 2019, an increase of 35%. In 2019, the top five provinces in China with more deaths caused by excessive intake of sugary beverages were Shandong, Henan, Hebei, Hunan and Guangdong, with the number of death cases 4337, 3881, 3010, 2762 and 2611, respectively. Conclusions The number of deaths and disease burdens caused by high sugar-sweetened beverages intake in China has increased significantly over the past three decades. The burden of disease due to high intake of sugary beverages varies widely from province to province. We suggest that attention should be paid to the problem of excessive intake of high sugar-sweetened beverages for Chinese population. In addition to regular monitoring and investigation of sugar-sweetened beverage intake, comprehensive measures should be taken in China’s sugar control work.

Objectives. To analyze diabetes mellitus (DM) mortality and years of life lost (YLL) in different years and different subgroups at the national and regional levels in China from 2005 to 2020. Methods. We estimated mortality and YLL of DM and its subcategories for 31 provinces in China during 2005–2020 using multisource data from the National Mortality Surveillance System (NMSS). Results. The age standardized mortality rate (ASMR) of DM increased from 12.18 per 100,000 in 2005 to 13.62 per 100,000 in 2020, which was an increase of 11.86%. The ASMR of type 2 diabetes mellitus (T2DM) was much higher than that of type 1 diabetes mellitus (T1DM). The ASMR of T1DM remained stable, but the rate of T2DM increased, and the increase in male patients was higher than that in their female counterparts. At the same time, the burden of premature death was highest in the group ≥ 80 years old, and ASMR increased from 236.02 per 100,000 in 2005 to 358.86 per 100,000 in 2020. In 2005, the eastern region had the highest ASMR of DM, but the western region’s ASMR grew faster and eventually became the highest in 2020. In addition, the YLL rate in the eastern region showed a downward trend; however, in the middle and western regions the YLL rate continued to rise, with that of the western region rapidly increasing. Conclusion. A dramatically upward trend in DM deaths can be seen in China from 2005 to 2020. DM remains a chronic disease in urgent need of prevention and control, especially in the elderly and people in less-affluent provinces. We must put forward more targeted policies to effectively allocate medical resources and focus on high-risk groups to reduce the premature-mortality burden of DM and its subcategories.

To examine the trends of nasopharyngeal carcinoma (NPC) mortality and years of life lost (YLL) in China and its provinces from 2005 to 2020, our study used data from China National Mortality Surveillance System (NMSS) to estimate the number and rate of mortality and YLL of NPC by age and sex. We calculated average annual percent change (AAPC) to describe the trend of NPC mortality and YLL over time. We also analyzed the proportion of NPC deaths in all cancer deaths and explored the drivers of change in NPC deaths by decomposition analysis. The age-standardized mortality rate (ASMR) of NPC in China had a significant downward trend from 2.0/100 000 in 2005 to 1.4/100 000 in 2020 (AAPC = -2.4, P .05). Age-standardized YLL rate also showed the similar trends (AAPC = -2.8, P .05). Southern provinces including Guangdong (163.9/100 000), Guangxi (130.5/100 000), and Hainan (105.6/100 000) had the highest YLL rate in 2020. The mortality and YLL rate increased with age and males were higher than females. From 2005 to 2020, the proportion of NPC deaths in all cancer deaths remained stable at around 1.0% in China. The total number of deaths of NPC increased by 7.3%, of which age-specific mortality, population growth, and population aging accounted for -46.2%, 8.5% and 45.0%, respectively. NPC remains a significant public health issue in China southern provinces and tailored prevention and control strategies should be strengthened to reduce the burden of premature mortality of NPC in high risk areas.

Objectives Cardiovascular disease (CVD) is leading cause of death in China. We aimed to provide national and subnational estimates and its change of premature mortality burden of CVD during 2005–2020. Methods Data from multi-source on the basis of national mortality surveillance system (NMSS) was used to estimate mortality and years of life lost (YLL) of total CVD and its subcategories in Chinese population across 31 provinces during 2005–2020. Results Estimated CVD deaths increased from 3.09 million in 2005 to 4.58 million in 2020; the age-standardized mortality rate (ASMR) decreased from 286.85 per 100,000 in 2005 to 245.39 per 100,000 in 2020. A substantial reduction of 19.27% of CVD premature mortality burden, as measured by age-standardized YLL rate, was observed. Ischemic heart disease (IHD), hemorrhagic stroke (HS) and ischemic stroke (IS) were leading 3 causes of CVD death. Marked differences were observed in geographical patterns for total CVD and its subcategories, and it appeared to be lower in areas with higher economic development. Population ageing was dominant driver contributed to CVD deaths increase, followed by population growth. And, age-specific mortality shifts contributed largely to CVD deaths decline in most provinces. Conclusion Substantial discrepancies were demonstrated in CVD premature mortality burden across China. Targeted considerations were needed to integrate primary care with clinical care through intensifying further strategies for reducing CVD mortality among specific subcategories, high risk population and regions with inadequate healthcare resources.

The distribution of temperature and temperature-health association varied largely across different regions in China, a region-specific definition for heatwave was therefore needed. We collected the data on daily mortality, meteorological factors and air pollution in 84 Chinese cities during 2013–2016, which was divided into seven regions. Based on the association between daily maximum temperature and mortality in each city in a threshold distributed lag non-linear model, where the threshold was defined as the temperature corresponding to the lowest mortality risk, we calculated the number of deaths that could be avoided for 1 °C decrease in maximum temperature under different thresholds, then a random-effect meta-analysis was used to generate regional results, in which the temperature with the highest avoidable mortality number for 1 °C decrease was considered as the most appropriate heatwave definition. We observed an immediate detrimental effect of high temperature within three lag days. Our analysis suggested to use 29.5 °C, 31.5 °C, 29.0 °C, 31.5 °C, 30.0 °C, and 28.5 °C as the heatwave standard for east, north, northeast, central, south, and southwest region, with the avoidable mortality number of 1.54 (95 % Confidence interval (CI): 0.88, 2.19), 0.55 (95 % CI: 0.16, 0.94), 0.59 (95 % CI: 0.32, 0.86), 1.14 (95 % CI: 0.68, 1.59), 1.22 (95 % CI: 0.54, 1.90), and 0.78 (95 % CI: 0.01, 1.55), respectively, while the estimated number 0.19 (95 % CI: −0.02, 0.40) in northwest region was not statistically significant. The concept of ‘avoidable mortality for 1 °C decrease’ was proposed to define the heatwave event, and varied maximum temperature between 28.5 and 31.5 °C was suggested for region-specific heatwave definition in China.

Background Chronic pain is a common disease; about 20% of people worldwide suffer from it. While compared with the research on the prevalence and management of chronic pain in developed countries, there is a relative lack of research in this field in China. This research aims to construct the China Pain Health Index (CPHI) to evaluate the current status of the prevalence and management of chronic pain in the Chinese population. Methods The dimensions and indicators of CPHI were determined through literature review, Delphi method, and analytical hierarchy process model, and the original values ​​of relevant indicators were obtained by collecting multi-source data. National and sub-provincial scores of CPHI (2020) were calculated by co-directional transformation, standardization, percentage transformation of the aggregate, and weighted summation. Results The highest CPHI score in 2020 is Beijing, and the lowest is Tibet. The top five provinces are Beijing (67.64 points), Shanghai (67.04 points), Zhejiang (65.74 points), Shandong (61.16 points), and Tianjin (59.99 points). The last five provinces are Tibet (33.10 points), Ningxia (37.24 points), Guizhou (39.85 points), Xinjiang (39.92 points), and Hainan (40.38 points). The prevalence of chronic pain is severe in Heilongjiang, Chongqing, Guizhou, Sichuan, and Fujian. Guizhou, Hainan, Xinjiang, Beijing, and Guangdong display a high burden of chronic pain. The five provinces of Guangdong, Shanghai, Beijing, Jiangsu, and Zhejiang have better treatment for chronic pain, while Tibet, Qinghai, Jilin, Ningxia, and Xinjiang have a lower quality of treatment. Beijing, Shanghai, Qinghai, Guangxi, and Hunan have relatively good development of chronic pain disciplines, while Tibet, Sichuan, Inner Mongolia, Hebei, and Guizhou are relatively poor. Conclusion The economically developed provinces in China have higher CPHI scores, while economically underdeveloped areas have lower scores. The current pain diagnosis and treatment situation in economically developed regions is relatively good, while that in financially underdeveloped areas is rather poor. According to the variations in the prevalence and management of chronic pain among populations in different provinces in China, it is necessary to implement chronic pain intervention measures adapted to local conditions.

China accounts for 13% of the world's 5-19-year-olds population. We estimated levels and trends of mortality by sex-age-cause among 5-19-year-olds at national and subnational levels in China annually from 2004 to 2019, to inform strategies for reducing child and adolescent mortality in China and other countries.We used adjusted empirical data on levels and causes of deaths from the China Center for Disease Control and Prevention's Disease Surveillance Point (DSP) system. We considered underreporting and surveillance sampling design, applied smoothing techniques to produce reliable time trends, and fitted age-specific deaths and population to national estimates produced by international agencies to allow for cross-national comparisons.The top leading causes for 54 594 deaths among 5-19-year-olds were neoplasms, road traffic injuries, and drowning. All-cause mortality in 5-19-year-olds has been declining steadily between 2004-2019, with evident yet narrowing geographical and gender disparities. Injury mortalities were one of the fastest declining causes, but widespread disparities were observed across subpopulations. Falling injuries and rising non-communicable diseases had the most pronounced epidemiological transition in the eastern region. Decrease in drowning fractions stalled for 15-19-year-olds in central/western rural areas. Suicide shares sustained or increased for 15-19-year-olds except among females in eastern rural areas.China made significant improvements in child and adolescent survival since 2004. However, constant targeted investments are needed to maintain and accelerate progress. A sustainable sample registration system like the DSP is likely essential for supporting such a process.

From 1990 to 2019, the age-standardized incidence rate of nutritional deficiencies in China remained stable. However, the age-standardized disability-adjusted life-years (DALY) rate of nutritional deficiencies decreased from 1990 to 2019. Data were extracted from the GBD 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess the incidence rate, and DALY trends of nutritional deficiencies. Measures were stratified by subtypes, regions, and age groups. In 2019, the age-standardized DALY rates of dietary iron deficiency and protein-energy malnutrition reached their highest levels. The main population groups with protein-energy malnutrition and dietary iron deficiency were adults over the age of 70 and children under the age of five. The latter group also had a greater burden of vitamin A deficiency. Zhejiang, Beijing, and Guangdong reported the highest age-standardized incidence rates of nutritional deficiencies, which mainly pertained to protein-energy malnutrition and vitamin A deficiency. Tibet, Xinjiang, and Hainan had the highest age-standardized DALY rates of nutritional deficiencies, which mainly pertained to dietary iron deficiency and protein-energy malnutrition.

The Air Quality Index (AQI) has been criticized because it does not adequately account for the health effect of multi-pollutants. Although the developed Air Quality Health Index (AQHI) is a more effective communication tool, little is known about the best method to construct AQHI on long time and large spatial scales.To further evaluate the validity of existing approaches to the establishment of AQHI on both long time and larger spatial scales.By introducing 3 approaches addressing multi-pollutant exposures: cumulative risk index (CRI), supervised principal component analysis (SPCA), and Bayesian multi-pollutants weighted model (BMP), we constructed CRI-AQHI, SPCA-AQHI, BMP-AQHI and standard-AQHI on cardiovascular mortality in China from 2015 to 2019 at both the national and geographic regional levels. We further assessed the performance of the four methods in estimating the joint effect of multi-pollutants by simulations under various scenarios of pollution effect.The results of national China showed that the BMP-AQHI improved the goodness of fit of the standard-AQHI by 108.24%, followed by CRI-AQHI (5.02%), and all AQHIs performed better than AQI, consistent with 6 geographic regional results. In addition, the simulation result showed that the BMP method provided stable and relatively accurate estimations of the short-term combined effect of exposure to multi-pollutants.AQHI based on BMP could communicate the air pollution risk to the public more effectively than the current AQHI and AQI.

The burden of non-communicable diseases (NCDs) has increased in China. However, the contribution of dietary risks to the NCD burden has not been evaluated. This study aimed to estimate the burden of ischemic heart disease (IHD) and colorectal cancer (CRC) attributable to a diet low in fiber in China from 1990 to 2017. China data from the Global Burden of Disease Study (GBD) 2017 were used to assess the age-, sex-, and province-specific mortality and disability-adjusted life-years (DALYs) of IHD and CRC related to a diet low in fiber. In 2017, a diet low in fiber contributed 170,143 [95% uncertainty interval (UI): 99,623–256,806] IHD deaths and 25,561 (95% UI: 13,726–39,215) CRC deaths, with the population attributable fractions (PAFs) were 9.7 and 13.7%, respectively. Males had higher risk-attributable mortality and DALY rates for IHD and CRC than females. An upward trend with age in rates of mortality and DALY was observed. All-age risk-attributable mortality and DALY rates increased significantly by 111.4 and 53.2% for IHD, and 94.4 and 59.6% for CRC from 1990 to 2017, respectively; however, the corresponding age-standardized rates for IHD and CRC showed relatively stable trends. Heilongjiang, Xinjiang, and Inner Mongolia were ranked as the top three provinces in terms of total risk-attributable NCD burden in 2017. China has a large and growing NCD burden attributable to a diet low in fiber. Greater priority in disease prevention and control should be given to male and older adults throughout China, particularly in some western provinces.

Introduction: Cardiovascular disease (CVD) is the leading cause of death and has caused a heavy burden in China. China has about 106 million CVD patients, including 33 million with stroke. This study presents the latest cardiovascular mortality in China in 2019 to provide evidence for disease control and prevention. Methods: Mortality data from the China Death Surveillance Point System (DSP System) was used for CVD mortality estimation. A descriptive analysis was conducted to demonstrate the results. Results: A total of 5.09 million CVD deaths were estimated in China in 2019, with a mortality rate and age-standardized mortality rate of 364.5 per 100,000 population and 276.0 per 100,000, respectively. Stroke is the leading cause of death, and the mortality rate and age-standardized mortality rate (ASMR) were 171.6 per 100,000 and 130.0 per 100,000, respectively. The second major cause was ischemic heart diseases, and the mortality rate and ASMR were 147.3 per 100,000 and 142.1 per 100,000, respectively. Stroke and ischemic heart diseases were the two major causes of CVD deaths, which accounted for over 87% of all CVD deaths. Conclusions: Although age-standardized mortality of CVD continues to decline in China, the number of deaths is still increasing. Therefore, prevention and control efforts for CVD should be maintained. In order to achieve the “Healthy China 2030” goal of reducing the mortality rate of CVD in China, it is necessary to further strengthen the prevention, control, and treatment capacity of stroke. Meanwhile, increases in ischemic heart disease deaths in highly developed areas should be monitored.

What is already known about this topic? Breast cancer is the most common cancer in women in China and around the world. By 2019, 121 countries have instituted a national screening program as a secondary prevention measure for breast cancer. What is added by this report? Breast cancer screening rates in China were 18.9% in women aged 20 years and above, and 25.7% in women aged 35–64 years in 2015. The screening rate for women aged 20 years and above was significantly higher in urban areas than in rural areas (24.6% vs. 15.0%), and in the eastern region than in the central and western regions (24.0% vs. 15.1% and 15.3%). What are the implications for public health practice? Continued efforts should be made to strengthen national and local policy initiatives and financial support for population-based, organized screening programs for breast cancer. Health education and accessibility of screening services to women across the country should be strengthened, especially for women aged 50 years and above.

Background Oral cancer is among the most common malignant tumors worldwide, and it has become an increasingly important public health problem in China. This study systematically assesses the current state of oral cancer in China from 1990 to 2017, providing new information and perspectives for oral health researchers and public health policy makers. Methods Based on the Global Burden of Disease, Injuries, and Risk Factors Study 2017 (GBD 2017), we evaluated the incidence rates, mortality and disability-adjusted life year (DALY) rates for oral cancer in China and their changing trends between 1990 and 2017, making comparisons by gender and age. We also assessed the DALY rates associated with oral cancer at the provincial level for 33 provinces and their trends over time. Results From 1990 to 2017, the number of new cases and the age-standardized incidence rate for oral cancer in China increased by 280.0% and 79.7%, respectively; the number of deaths and the age-standardized mortality rose by 196.8% and 29.0%, respectively; and the number of DALYs and the age-standardized DALY rate increased by 149.1% and 21.0%, respectively. The incidence rates for oral cancer rose after 30 years of age and peaked at 65–69 years; the mortality for oral cancer rose after 50 years of age and peaked at 65–69 years; and the DALY rates for oral cancer rose after 45 years of age and peaked at 65–69 years. The incidence rates, mortality and DALY rates for oral cancer in males were significantly higher than those in females and showed an upward trend, while there was a decrease or no significant change in females. The DALY rates increased in 21 provinces and decreased in 12 provinces, with the largest growth in Henan Province and the largest decline in Hong Kong Province. Conclusions The burden of oral cancer in China continues to increase continuously. More prevention, control and intervention measures should be taken and increased attention paid to common risk factors is essential for the prevention of oral cancer.

Most previous studies used a specific size of particulate matter (PMx) for dosimetry estimation when determining particulate matter (PM)-associated risk, which precluded the impact of other sizes o...

Summary Background Vision loss is an important public health issue in China, but a detailed understanding of national and regional trends in its prevalence and causes, which could inform health policy, has not been available. This study aimed to assess the prevalence, causes, and regional distribution of vision impairment and blindness in China in 1990 and 2019. Methods Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used to estimate the prevalence of moderate and severe vision impairment and blindness in China and compare with other Group of 20 (G20) countries. We used GBD methodology to systematically analyse all available demographic and epidemiological data at the provincial level in China. We compared the age-standardised prevalences across provinces, and the changes in proportion of vision loss attributable to various eye diseases in 1990 and 2019. We used two different counterfactual scenarios with respect to population structure and age-specific prevalence to assess the contribution of population growth and ageing to trends in vision loss. Findings In 2019, the age-standardised prevalence was 2·57% (uncertainty interval [UI] 2·28–2·86) for moderate vision impairment, 0·25% (0·22–0·29) for severe vision impairment, and 0·48% (0·43–0·54) for blindness in China, which were all below the global average, but the prevalence of moderate and severe vision impairment had increased more rapidly than in other G20 countries from 1990 to 2019. The prevalence of vision loss increased with age, and the main causes of vision loss varied across age groups. The leading causes of vision impairment in China were uncorrected refractive error, cataract, and macular degeneration in both 1990 and 2019 in the overall population. From 1990 to 2019, the number of people with moderate vision impairment increased by 133·67% (from 19·65 to 45·92 million), those with severe vision impairment increased by 147·14% (from 1·89 to 4·67 million), and those with blindness increased by 64·35% (from 5·29 to 8·69 million); in each case, 20·16% of the increase could be explained by population growth. The contributions to these changes by population ageing were 87·22% for moderate vision impairment, 116·06% for severe vision impairment, and 99·22% for blindness, and the contributions by age-specific prevalence were 26·29% for moderate vision impairment, 10·91% for severe vision impairment, and −55·04% for blindness. The prevalence and specific causes of vision loss differed across provinces. Interpretation Although a comprehensive national policy to prevent blindness is in place, public awareness of visual health needs improving, and reducing the prevalence of moderate and severe vision impairment should be prioritised in future work. Funding China National Key Research and Development Programme and Beijing Municipal Special Funds for Medical Research on Public Welfare Development and Reform.

ObjectivesThis study explored the prevalence of and individual influencing factors for metabolic syndrome (MS) as well as associated socioeconomic factors and regional aggregation.DesignFour cross-sectional surveys were analysed for trends in MS and associations with socioeconomic and individual factors through multilevel logistic regression analyses. The risk associated with nutrient intake was also assessed through a dietary survey in 2015.SettingFrom 2010 to 2018, 8–15 counties/districts of West China were included.ParticipantsA total of 28 274 adults were included in the prevalence analysis. A total of 23 708 adults were used to analyse the related factors.ResultsThe overall prevalence of MS ranged from 21.4% to 27.8% over the 8 years, remaining basically stable within the 95% CI. Our study found that the urbanisation rate and hospital beds per 1000 people were positively associated with MS, and the number of doctors in healthcare institutions per 1000 persons was negatively associated with MS. The ORs for females, people with college education and higher and unmarried or single people were 1.49, 0.67 and 0.51, respectively (pConclusionThe high burden of MS, unreasonable proportions of energy and micronutrient intake and low percentage of high levels of physical activity were the major challenges to public health in western China. Improving the human resources component of medical services, such as the number of doctors, increasing the availability of public sports facilities and E-health tools and improving individual dietary quality and education might help prevent MS.

Wei Liu,* Wei Wang,* Jiangmei Liu, Yunning Liu, Shidi Meng, Feixue Wang, Zheng Long, Jinlei Qi, Jinling You, Lin Lin, Lijun Wang, Maigeng Zhou, Peng Yin National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Peng YinNational Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing, 100050, People’s Republic of ChinaTel +86 010-63015058Email yinpeng@ncncd.chinacdc.cnBackground: To examine trends in chronic obstructive pulmonary disease (COPD) mortality and years of life lost (YLL) due to COPD for all provinces in China during 2005– 2020.Methods: Data for COPD mortality were derived from China National Mortality Surveillance System (NMSS). We analyzed the numbers and age-standardized rates of death and YLL due to COPD in China, during 2005– 2020. We carried out decomposition analysis to analyze the drivers of change in COPD deaths during the study period.Results: The age-standardized mortality rate of COPD in China decreased significantly from 99.5/100,000 in 2005 to 50.5/100,000 in 2020. Similar trend was seen in the age-standardized YLL rate. The mortality rate increased with age. During 2005– 2020, the age-standardized mortality rate decreased in all provinces (except for Tibet) with the largest decline in Jilin (− 77.8%), Henan (− 68.4%) and Fujian (− 67.1%). The decreased number of deaths was decomposed as population growth (8.5%) and population ageing (69.7%) with offset by decline of age-specific mortality (− 87.5%).Conclusion: COPD remains an important public health problem in China, though significant reductions of COPD mortality and YLL rate were observed. Vigorous prevention and control strategies should be enhanced to improve the quality of life of COPD patients and reduce the premature death caused by COPD in Chinese population.Keywords: COPD, mortality, YLL

The aim of this study was to estimate the burden of ischemic heart disease (IHD) and type 2 diabetes mellitus (T2DM) attributable to a diet high in sugar-sweetened beverages (SSBs) in China from 1990 to 2017.Data from the Global Burden of Disease Study 2017 were used to assess all-age and age-standardized, risk-attributable mortality, years of life lost (YLL), years of life with disability (YLD), and disability-adjusted life years (DALYs) by age, sex, year, province, and sociodemographic index (SDI).For total noncommunicable diseases (NCDs), 12 523 (95% uncertainty interval 776-27 631) deaths, 305 288 (18 611-661 847) YLL, 142 051 (64 530-257 468) YLD, and 447 339 (132 677-858 838) DALYs were attributable to diet high in SSBs in 2017, particularly among males. Age-standardized, risk-attributable mortality, YLL, YLD, and DALY rates increased distinctly by 507.3%, 410.3%, 571.0%, and 453.3% from 1990 to 2017 respectively. Age-sex-specific, risk-attributable mortality and YLL rates for IHD in older adults (over 65 years) were higher than in young (between 25 and 39 years) and middle-aged adults (between 40 and 64 years) in 2017; however, the YLD and DALY rates for T2DM were higher in young and middle-aged males than in older males. The age-standardized, risk-attributable DALY rates for total NCDs increased substantially in high-SDI and high-middle-SDI provinces during the period.China has a huge and growing burden of IHD and T2DM attributable to diet high in SSBs, particularly among young and middle-aged male adults in wealthier provinces. Evidence-based public health policies at the provincial levels to reduce the consumption of SSBs should be prioritized in China.目的: 估计中国1990年至2017年高糖饮料所导致的缺血性心脏病和2型糖尿病的疾病负担。 方法: 使用2017年全球疾病负担研究的数据; 按年龄、性别、年份、省份和社会人口指数评估归因于高糖饮料的缺血性心脏病和2型糖尿病的死亡率、早死所致寿命损失(YLL)、伤残所致寿命损失(YLD)和伤残调整寿命年(DALY)数及标化率。 结果: 2017年归因于高糖饮料的慢性病总死亡人数12523人(776-27631); 早死所致寿命损失为305288人年(18611-661847); 伤残所致寿命损失为142051人年(64530-257468); 伤残调整寿命年为447339人年(132677-858838); 以男性为主。1990年至2017年; 年龄标化的死亡率、YLL、 YLD 和DALY率分别增加了507.3%、410.3%、571.0%和453.3%。2017年; 老年人群(65岁以上)缺血性心脏病的死亡率和YLL率高于年轻人(25-39岁)和中年人(40-64岁); 然而; 对2型糖尿病来说; 青年和中年男性的YLD率和DALY率高于老年男性。1990-2017年; 在高SDI和高-中SDI的省份; 慢性病的标化DALY率大大增加。 结论: 中国归因于高糖饮料的缺血性心脏病和2型糖尿病的疾病负担呈现增长趋势; 特别是在较富裕省份的年轻和中年男性人群中。基于这些证据; 应优先考虑减少高糖饮料消费的公共卫生决策。.

Background Colorectal cancer (CRC) has emerged as a major public health concern. However, little is known about the burden attributable to specific risk factors. The present study aimed to estimate the temporal trends and geographical variation of CRC burden attributable to a diet low in milk in China. Methods Following the general analytic strategy used in the 2017 Global Burden of Disease study, we assessed the age-, sex-, and province-specific mortality and disability-adjusted life-years (DALYs) of CRC caused by a diet low in milk in China from 1990 to 2017. Results In 2017, a diet low in milk contributed 32 032 [95% uncertainty interval (UI) = 11 350-53 806] deaths and 726 710 (95% UI = 256 651-1 218 153) DALYs for CRC with a population attributable fraction of 17.1%. The age-standardised mortality and DALY rates per 100 000 were 1.7 (95% UI = 0.6-2.9) and 36.8 (95% UI = 13.0-61.7), respectively. An upward trend with age in rates of mortality and DALYs was observed. Males had higher age-standardised rates than females. The number of deaths and DALYs increased significantly from 1990 to 2017, whereas the corresponding age-standardised rates showed relatively stable trends. In 2017, Hunan and Liaoning were ranked as the top two provinces in terms of disease burden. Socio-demographic index had a weak correlation with the age-standardised mortality (r = 0.348, P = 0.047). Conclusions The present study shows a substantial increase in the CRC burden attributable to a diet low in milk over the past three decades. Greater priority in CRC prevention should be given to males and the elderly population throughout China, particularly in less-developed provinces.

Summary Background Air pollution is an important public health concern in China, with high levels of exposure to both ambient and household air pollution. To inform action at provincial levels in China, we estimated the exposure to air pollution and its effect on deaths, disease burden, and loss of life expectancy across all provinces in China from 1990 to 2017. Methods In all 33 provinces, autonomous regions, municipalities, and special administrative regions in China, we estimated exposure to air pollution, including ambient particulate matter pollution (defined as the annual gridded concentration of PM2·5), household air pollution (defined as the percentage of households using solid cooking fuels and the corresponding exposure to PM2·5), and ozone pollution (defined as average gridded ozone concentrations). We used the methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 to estimate deaths and disability-adjusted life-years (DALYs) attributable to air pollution, and what the life expectancy would have been if air pollution levels had been less than the minimum level causing health loss. Findings The average annual population-weighted PM2·5 exposure in China was 52·7 μg/m3 (95% uncertainty interval [UI] 41·0–62·8) in 2017, which is 9% lower than in 1990 (57·8 μg/m3, 45·0–67·0). We estimated that 1·24 million (95% UI 1·08–1·40) deaths in China were attributable to air pollution in 2017, including 851 660 (712 002–990 271) from ambient PM2·5 pollution, 271 089 (209 882–346 561) from household air pollution from solid fuels, and 178 187 (67 650–286 229) from ambient ozone pollution. The age-standardised DALY rate attributable to air pollution was 1513·1 per 100 000 in China in 2017, and was higher in males (1839·8 per 100 000) than in females (1198·3 per 100 000). The age-standardised death rate attributable to air pollution decreased by 60·6% (55·7–63·7) for China overall between 1990 and 2017, driven by an 85·4% (83·2–87·3) decline in household air pollution and a 12·0% (1·4–22·1) decline in ambient PM2·5 pollution. 40·0% of DALYs for COPD were attributable to air pollution, as were 35·6% of DALYs for lower respiratory infections, 26·1% for diabetes, 25·8% for lung cancer, 19·5% for ischaemic heart disease, and 12·8% for stroke. We estimated that if the air pollution level in China was below the minimum causing health loss, the average life expectancy would have been 1·25 years greater. The DALY rate per 100 000 attributable to air pollution varied across provinces, ranging from 482·3 (371·1–604·1) in Hong Kong to 1725·6 (720·4–2653·1) in Xinjiang for ambient pollution, and from 18·7 (9·1–34·0) in Shanghai to 1804·5 (1339·5–2270·1) in Tibet for household pollution. Although the overall mortality attributable to air pollution decreased in China between 1990 and 2017, 12 provinces showed an increasing trend during the past 27 years. Interpretation Pollution from ambient PM2·5 and household burning of solid fuels decreased markedly in recent years in China, after extensive efforts to control emissions. However, PM2·5 concentrations still exceed the WHO Air Quality Guideline for the entire population of China, with 81% living in regions exceeding the WHO Interim Target 1, and air pollution remains an important risk factor. Sustainable development policies should be implemented and enforced to reduce the impact of air pollution on long-term economic development and population health. Funding Bill & Melinda Gates Foundation; and China National Key Research and Development Program.

Background Death registration completeness has never been assessed at the county level in China. Such analyses would provide critical intelligence to monitor the performance of the vital registration system and yield adjustment factors to correct death registration data, thereby increasing their policy utility. Methods We estimated the completeness of death registration for 31 provinces and 2844 counties of China in 2018 based on death data from the China Cause of Death Reporting System (CDRS) by using the empirical completeness method. We computed the root mean square difference (RMSD) of county-level completeness compared with provincial-level completeness to study intra-provincial variations. A two-level (province and county) logistic regression model was fitted to explore the association between county-level registration completeness and a set of covariates reflecting socioeconomic status, healthcare quality, and specific strategies and regulations designed to improve registration. Results In 2018, the overall death registration completeness for the CDRS in China was 74.2% (95% uncertainty interval [UI] 66.2–80.4), with very little difference for males and females. Geographical differences in completeness were higher across counties than across provinces. The county-level completeness ranged from 2.4% (95% UI 1.0–5.0%) in Burang County, Tibet, to 100.0% (95% UI 99.9–100.0%) in Guandu District, Yunnan. The coastal provinces of Jiangsu, Guangdong, and Fujian, with higher overall completeness, contained counties with low completeness; conversely, the underdeveloped provinces of Guangxi and Guizhou, with lower overall completeness, included some counties with high completeness. GDP, education, population density, minority population, healthcare access, and registration strategies were important drivers of the geographical differences in registration completeness. Conclusions There are marked inequalities in registration completeness at the county level and within provinces in China. The socioeconomic condition, the implementation of specific registration-enhancing initiatives, and the availability and quality of medical care were the primary drivers of the observed geographical variation. A more strategic approach, with more research, is required to identify the main reasons for death under-reporting, especially in the poorer performing counties, to guide remedial action.

Background Depression in China has risen from the 15th leading cause of all-cause disability-adjusted life years (DALYs) in 1990 to the 10th in 2017. However, the burden of depression and the epidemiological trend in Chinese provinces remain unclear. This study aimed to estimate the prevalence and burden of depression among different sexes, ages, disease types and provincial administrative units in China. Methods Based on a general analysis of the Global Burden of Disease study (GBD) in 2017, we analyzed the age- sex- and province-specific prevalence and DALYs of depression in China from 1990 to 2017. Results From 1990 to 2017, the all-age prevalence rate of depression per 100,000 rose from 3224.6 (95% UI:2976.6–3509.1) to 3990.5 (95% UI: 3667.8–4353.0), and the DALY rate per 100,000 rose from 525.1 (95% UI: 373.5–719.0) to 607.4 (95% UI: 427.7–820.2). The prevalence rate decreased in the population aged 5–54 years, and increased in the population aged over 55 years. In 2017, the prevalence rate of females (5039.6, 95% UI: 4630.0–5502.8) was significantly higher than that of males (2984.9, 95% UI: 2736.0–3265.3). The prevalence and DALY rate increased in all provinces. However, the age-standardized prevalence and DALYs rate decreased in 31 provinces. Conclusions Depression has gradually become a major public health issue in China. The government should take measures to prevent the development of depression immediately. Women and the elderly are at high risk for depression.

Ambient air pollution may be associated with diabetes mellitus. However, evidence from developing countries is limited although the concentrations of air pollution are disproportionably higher in these countries. We collected daily data on diabetes mortality, air pollution, and weather conditions from 16 Chinese provincial cities during 2007–2013. A quasi-Poisson regression combined with a distributed lag model was used to quantify the city-specific mortality risk of PM10 (particulate matter with aerodynamic diameter