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1. Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked.

Author: Zhou M, Liu S, Kate Bundorf M, Eggleston K, and Zhou S
Subjects: Adult, China, Humans, Rural Population, Insurance Coverage statistics & numerical data, Insurance, Health statistics & numerical data, Mortality trends, Rural Health Services trends
Abstract: Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004-12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage., (Project HOPE—The People-to-People Health Foundation, Inc.)
Published: 2017
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2. Ambient particulate matter and chronic obstructive pulmonary disease mortality: a nationwide, individual-level, case-crossover study in ChinaResearch in context

Author: Shuo Jiang, Xunliang Tong, Kexin Yu, Peng Yin, Su Shi, Xia Meng, Renjie Chen, Maigeng Zhou, Haidong Kan, Yue Niu, and Yanming Li
Subjects: Fine particulate matter, Coarse particulate matter, COPD, Mortality, Case-crossover study, Medicine, Medicine (General), R5-920
Abstract: Summary: Background: Short-term exposure to particulate matter air pollution has been associated with the exacerbations of COPD, but its association with COPD mortality was not fully elucidated. We aimed to assess the association between short-term particulate matter exposure and the risk of COPD mortality in China using individual-level data. Methods: We derived 2.26 million COPD deaths from a national death registry database in Chinese mainland between 2013 and 2019. Exposures to fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) were assessed by satellite-based models of a 1 × 1 km resolution and assigned to each individual based on residential address. The associations of PM2.5 and PM2.5-10 with COPD mortality were examined using a time-stratified case-crossover design and conditional logistic regressions with distributed lag models. We further conducted stratified analyses by age, sex, education level, and season. Findings: Short-term exposures to both PM2.5 and PM2.5-10 were associated with increased risks of COPD mortality. These associations appeared and peaked on the concurrent day, attenuated and became nonsignificant after 5 or 7 days, respectively. The exposure-response curves were approximately linear without discernible thresholds. An interquartile range increase in PM2.5 and PM2.5-10 concentrations was associated with 4.23% (95% CI: 3.75%, 4.72%) and 2.67% (95% CI: 2.18%, 3.16%) higher risks of COPD mortality over lag 0–7 d, respectively. The associations of PM2.5 and PM2.5-10 attenuated slightly but were still significant in the mutual-adjustment models. A larger association of PM2.5-10 was observed in the warm season. Interpretation: This individual-level, nationwide, case-crossover study suggests that short-term exposure to PM2.5 and PM2.5-10 might act as one of the environmental risk factors for COPD mortality. Funding: This study is supported by the National Key Research and Development Program of China (2023YFC3708304 and 2022YFC3702701), the National Natural Science Foundation of China (82304090 and 82030103), the 3-year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.2-YQ31), and the Science and Technology Commission of Shanghai Municipality (21TQ015).
Published: 2024
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3. Disease burden of Parkinson's disease in China and its provinces from 1990 to 2021: findings from the global burden of disease study 2021Research in context

Author: Tingling Xu, Wenlan Dong, Jinli Liu, Peng Yin, Zhihui Wang, Lei Zhang, and Maigeng Zhou
Subjects: Epidemiology, Parkinson's disease, Global burden of disease study, Incidence, Prevalence, Mortality, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Parkinson's disease (PD) has become a public health concern with global ageing. However, comprehensive assessments of the temporal and geographical trend of PD disease burden in China remain insufficient. This study aimed to examine the burden of PD by age, gender, and geographical region in China during 1990–2021. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analysed the incidence, prevalence, mortality, and DALY burden of PD in 33 Chinese provinces/regions. We compared the national figure with the global average and the corresponding estimates from the G20 countries. The estimated annual percentage change (EAPC) was used to quantify the temporal trends of PD burden during 1990–2021. We further assessed the PD burden by age and gender during 1990–2021. We used a decomposition analysis to investigate the changes in the number of new cases, patients, and deaths of PD during 1990–2021. Findings: In 2021, China recorded the highest age-standardised incidence and prevalence of PD among the G20 countries, at 24.3 per 100,000 and 245.7 per 100,000, respectively, figures that were much higher than the global average. During 1990–2021, the age-standardised incidence of PD in China increased by 89.7%, and the age-standardised prevalence by 167.8%, both marking the largest increases among the G20 countries. In contrast, the age-standardised mortality for PD has significantly decreased since 1990, whereas the age-standardised DALY rate for PD has remained relatively unchanged since 1990. The PD burden gradually increased with age, especially in the elderly population aged ≥65 years. During 1990–2021, the burden in males consistently surpassed that in females, with the gender difference widening over time. The increase in new cases and patients of PD was primarily driven by changes in age-specific rates, while the rise in PD-related deaths was largely attributable to population ageing. The disease burden of PD varied considerably across the Chinese provinces. In 2021, age-standardised incidence and prevalence of PD were generally higher in China's southeastern coastal regions than in the western regions, and age-standardised DALY rates were higher in the northern regions than in other regions. Interpretation: The disease burden of PD in China has consistently risen over the past three decades, particularly among elderly men. The increasing causative factors and population aging highlight the need for enhancing public health intervention and resource allocation, especially in etiological research, early diagnosis, preventive strategies, and region-specific management for PD. Funding: Ministry of Science and Technology of the People's Republic of China (2022YFC2304900, 2022YFC2505100); National Key R&D Program of China (2022YFC2505100, 2022YFC2505103, 2018YFC1315300); Outstanding Young Scholars Support Program (grant number: 3111500001); Epidemiology modeling and risk assessment (grant number: 20200344), and Xi'an Jiaotong University Young Scholar Support Grant (grant number: YX6J004).
Published: 2024
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4. Mortality and years of life lost due to pancreatic cancer in China, its provinces, urban and rural areas from 2005 to 2020: results from the national mortality surveillance system

Author: Yangyang Xu, Wei Liu, Zheng Long, Lijun Wang, Maigeng Zhou, and Peng Yin
Subjects: Pancreatic cancer, Mortality, Years of life lost, Decomposition analysis, Disease burden, China, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background Pancreatic cancer is a growing public health concern in China, and depicting it from different perspectives would provide a comprehensive understanding of its epidemiological characteristics. Methods Data from the National Mortality Surveillance System (NMSS) in China was used to estimate the number of deaths, years of life lost (YLL), age-standardized mortality rate (ASMR) and age-standardized YLL rate in China, its provinces and urban-rural areas from 2005 to 2020. Joinpoint regression analysis was employed to explore the temporal trends of ASMR and age-standardized YLL rate. Decomposition analysis was conducted to assess the contribution of population growth, population aging and cause-specific mortality rate to the increment of pancreatic cancer deaths. Results A total of 100,427 pancreatic cancer deaths and 2,166,355 pancreatic cancer related YLL were estimated in China in 2020. The overall ASMR significantly increased from 6.6/100 000 in 2005 to 7.4/100 000 in 2020, and was higher in men than that in women. Age-standardized YLL rate showed a similar trend. The mortality rates of pancreatic cancer were generally higher in northeast China than in southwest China. The highest ASMRs were found in Jilin, Zhejiang, Inner Mongolia and Anhui, and the lowest ones in Guangxi, Yunnan, Tibet, and Hainan. The disease burden due to pancreatic cancer presented a significant upward trend in rural areas and a downward trend in urban areas. Conclusions The burden associated with pancreatic cancer had been increasing in China from 2005 to 2020. The escalating disease burden of pancreatic cancer in rural areas necessitates the implementation of effective control and prevention measures. Relevant provinces should pay greater attention to the prevailing of pancreatic cancer, particularly those exhibiting higher mortality rates.
Published: 2023
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5. Socioeconomic inequalities in dementia burden related to high body mass index, 2005–2018: findings from 1.25 million Chinese adultsResearch in context

Author: Yixin Tian, Zhenping Zhao, Xue Cao, Yuting Kang, Limin Wang, Peng Yin, Yuxin Song, Xin Wang, Congyi Zheng, Yuehui Fang, Mei Zhang, Yuna He, Zhen Hu, Jiayin Cai, Runqing Gu, Xuyan Pei, Xue Yu, Maigeng Zhou, and Zengwu Wang
Subjects: Disease burden, Obesity, Dementia, Year of life lost, Mortality, Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Dementia has become a major public health concern worldwide, but comprehensive assessments of dementia burden attributable to high body mass index (BMI) in China have not been done. Methods: We used a temporal-spatial Bayesian hierarchical model to estimated BMI levels based on 1.25 million Chinese. We estimated dementia burden attributable to high BMI by age, sex, year, and socioeconomic development in terms of deaths and years of life lost (YLLs) and assessed the effect of population ageing. Findings: The average age-standardised BMI was 24.58 kg/m2 and 24.15 kg/m2 for men and women in 2018, respectively. 12,901 (95% UI, 10,617–15,420) dementia deaths were attributable to high BMI in China in 2018, with 5417 deaths from man and 7421 deaths from woman. The attributable age-standardised YLL rates for dementia increased 27% from 2005 to 2018. The attributable age-standardised mortality rates increased with human development index. People aged 80 years and older had the highest attributable mortality rate, and the rate decreased with decreasing age. Population ageing was an important component of the increase in dementia death. Interpretation: The rapid increase and large inequality highlighted the urgent need for evidence-based policies and interventions. We therefore call for establishing stronger anti-dementia strategies to promote the healthy ageing. Funding: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.
Published: 2023
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6. Light at night and cause-specific mortality risk in Mainland China: a nationwide observational study

Author: Yao Lu, Peng Yin, Jie Wang, Yiping Yang, Fei Li, Hong Yuan, Shenxin Li, Zheng Long, and Maigeng Zhou
Subjects: Light at night, Mortality, Cause-specific mortality, Nationwide study, Time-stratified case-crossover study, Medicine
Abstract: Abstract Background While epidemiological studies have found correlations between light at night (LAN) and health effects, none has so far investigated the impacts of LAN on population mortality yet. We aimed to estimate the relative risk for mortality from exposure to LAN in Mainland China. Methods This time-stratified case-crossover nationwide study used NPP-VIIRS to obtain daily LAN data of Mainland China between 2015 and 2019. The daily mortality data were obtained from the Disease Surveillance Point System in China. Conditional Poisson regression models were applied to examine the relative risk (RR) for mortality along daily LAN in each county, then meta-analysis was performed to combine the county-specific estimates at the national or regional level. Results A total of 579 counties with an average daily LAN of 4.39 (range: 1.02–35.46) were included in the main analysis. The overall RRs per 100 nW/cm2/sr increases in daily LAN were 1.08 (95%CI: 1.05–1.11) for all-cause mortality and 1.08 (95%CI: 1.05–1.11) for natural-cause mortality. A positive association between LAN and all natural cause-specific mortality was observed, of which the strongest effect was observed on mortality caused by neuron system disease (RR = 1.32, 95%CI: 1.14–1.52). The results were robust in both younger and old, as well as in males and females. The more pronounced effect of LAN was observed in median LAN-level regions. Combined with an exposure–response curve, our study suggests a non-linear association between LAN and mortality in China. Conclusions Our study shows LAN is associated with mortality in China, particularly for neuron system disease-related mortality. These findings have important implications for public health policy establishment to minimize the health consequences of light pollution.
Published: 2023
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7. The Establishment of a New Air Health Index Integrating the Mortality Risks Due to Ambient Air Pollution and Non-Optimum Temperature

Author: Qingli Zhang, Renjie Chen, Guanjin Yin, Xihao Du, Xia Meng, Yang Qiu, Haidong Kan, and Maigeng Zhou
Subjects: Air pollution, Temperature, Air Health Index, Mortality, Time-series, Risk communication, Engineering (General). Civil engineering (General), TA1-2040
Abstract: A composite Air Health Index (AHI) is helpful for separately emphasizing the health risks of multiple stimuli and communicating the overall risks of an adverse atmospheric environment to the public. We aimed to establish a new AHI by integrating daily mortality risks due to air pollution with those due to non-optimum temperature in China. Based on the exposure-response (E-R) coefficients obtained from time-series models, the new AHI was constructed as the sum of excess mortality risk associated with air pollutants and non-optimum temperature in 272 Chinese cities from 2013 to 2015. We examined the association between the “total AHI” (based on total mortality) and total mortality, and further compared the ability of the “total AHI” to predict specific cardiopulmonary mortality with that of “specific AHIs” (based on specific mortalities). On average, air pollution and non-optimum temperature were associated with 28.23% of daily excess mortality, of which 23.47% was associated with non-optimum temperature while the remainder was associated with fine particulate matter (PM2.5) (1.12%), NO2 (2.29%,), and O3 (2.29%). The new AHI uses a 10-point scale and shows an average across all 272 cities of 6 points. The E-R curve for AHI and mortality is approximately linear, without any thresholds. Each one unit increase in “total AHI” is associated with a 0.84% increase in all-cause mortality and 1.01%, 0.98%, 1.02%, 1.66%, and 1.71% increases in cardiovascular disease, coronary heart disease, stroke, respiratory diseases, and chronic obstructive pulmonary disease mortality, respectively. Cause-specific mortality risk estimates using the “total AHI” are similar to those predicted by “specific AHIs.” In conclusion, the “total AHI” proposed herein could be a promising tool for communicating health risks related to exposure to the ambient environment to the public.
Published: 2022
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8. The burden of aortic aneurysm in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019

Author: Xinran Hou, Fan Zhang, Zhi Ye, Qian Xu, Lingjin Huang, Qulian Guo, Wei Liu, Lijun Wang, Maigeng Zhou, Peng Yin, and Maoen Zhu
Subjects: Aortic aneurysm, Global Burden of Disease Study, Mortality, China, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Aortic aneurysm (AA) is a global public health concern. However, little is known about the disease burden of AA in China. Methods Following the general analytic strategy used in the Global Burden of Disease Study (GBD) 2019, we analyzed the mortality and years of life lost (YLLs) due to AA, stratified by sex, age, and province-level region in China from 1990 to 2019. The temporal trend of AA burden in China was analyzed and the main attributable risk factors for AA in China were also explored. Results In China, the total AA deaths were 17,038 (95% UI: 14,392-19,980) in 2019, an increase of 136.1% compared with that in 1990, with an age-standardized death rate (ASDR) of 0.93 (95% UI: 0.79-1.08) per 100,000 person-years in 2019, a decrease of 6.8%. Meanwhile AA caused 378,578 (95% UI: 315,980-450,479) YLLs in 2019, an increase of 102.6% compared with that in 1990, with a crude YLL rate of 26.6 (95% UI: 22.2-31.7) per 100,000 person-years, an increase of 68.6%. The AA mortality and YLLs were higher in males than in females. AA caused most YLLs in the 65- to 75-year-old age group. The AA mortality and YLLs varied significantly among provinces in China, and the change in ASDR showed a negative correlation with the sociodemographic index of different provinces, namely, more decline of ASDR in developed provinces. High systolic blood pressure was shown to be the most significant attributable risk factor for AA burden in both males and females, and smoking was another major attributable risk factor, especially in males. Conclusions The disease burden of AA increased significantly from 1990 to 2019 in China, with higher mortality and YLLs in males, senior populations, and among residents of most western provinces in China. High systolic blood pressure and smoking were two major attributable risk factors for AA mortality in China.
Published: 2022
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9. Association between ambient sulfur dioxide pollution and asthma mortality: Evidence from a nationwide analysis in China

Author: Wei Liu, Miao Cai, Zheng Long, Xunliang Tong, Yanming Li, Lijun Wang, Maigeng Zhou, Jing Wei, Hualiang Lin, and Peng Yin
Subjects: Sulfur dioxide, Asthma, Mortality, Air pollution, Time-stratified case-crossover, Environmental pollution, TD172-193.5, Environmental sciences, GE1-350
Abstract: There is a lack of research on the effects of acute exposure to ambient sulfur dioxide (SO2) on mortality caused by asthma, especially nationwide research in China. To explore the acute effect of exposure to ambient SO2 on asthma mortality using nationwide dataset in China from 2015 to 2020 and further evaluate the associations in subgroups with different geographical and demographic characteristics. We used data from China’s Disease Surveillance Points system with 29,553 asthma deaths in China during 2015–2020. The exposure variable was the daily mean concentrations of SO2 from the ChinaHighSO2 10 km × 10 km daily grid dataset. Bilinear interpolation was used to estimate each individual’s exposure to air pollutants and meteorological variables. We used a time-stratified case crossover design at the individual level to analyze the exposure response relationship between short-term exposure to SO2 and asthma mortality. Stratified analyses were carried out by sex, age group, marital status, warm season and cold season, urbanicity and region. Significant associations between short-term exposure to ambient SO2 and increased asthma mortality were found in this nationwide study. The excess risk (ER) for each 10 μg/m3 increase in SO2 concentrations at lag07 was 7.78 % (95 % CI, 4.16–11.52 %). Season appeared to significantly modify the association. The associations were stronger in cold season (ER 9.78 %, 95 % CI:5.82 −13.89 %). The association remained consistent using different lag periods, adjusting for other pollutants, and in the analysis during pre-Corona Virus Disease 2019 (COVID-19) period. Our study indicates increased risk of asthma mortality with acute exposures to SO2 in Chinese population. The current study lends support for greater awareness of the harmful effect of SO2 in China and other countries with high SO2 pollution.
Published: 2023
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10. The joint and interaction effect of high temperature and humidity on mortality in China

Author: Wen Fang, Zhixing Li, Jinghua Gao, Ruilin Meng, Guanhao He, Zhulin Hou, Sui Zhu, Maigeng Zhou, Chunliang Zhou, Yize Xiao, Min Yu, Biao Huang, Xiaojun Xu, Lifeng Lin, Jianpeng Xiao, Donghui Jin, Mingfang Qin, Peng Yin, Yiqing Xu, Jianxiong Hu, Tao Liu, Cunrui Huang, and Wenjun Ma
Subjects: Temperature, Relative humidity, Interaction effect, Mortality, Environmental sciences, GE1-350
Abstract: Background: Although many studies have reported the mortality effect of temperature, there were few studies on the mortality risk of humidity, let alone the joint effect of temperature and humidity. This study aimed to investigate the joint and interaction effect of high temperature and relative humidity on mortality in China, which will deepen understanding the health risk of mixture climate exposure. Methods: The mortality and meteorological data were collected from 353 locations in China (2013–2017 in Jilin, Hunan, Guangdong and Yunnan provinces, 2009–2017 in Zhejiang province, and 2006–2011 in other Provinces). We defined location-specific daily mean temperature ≥ 75th percentile of distribution as high temperature, while minimum mortality relative humidity as the threshold of high relative humidity. A time-series model with a distributed lag non-linear model was first employed to estimate the location-specific associations between humid-hot events and mortality, then we conducted meta-analysis to pool the mortality effect of humid-hot events. Finally, an additive interaction model was used to examine the interactive effect between high temperature and relative humidity. Results: The excess rate (ER) of non-accidental mortality attributed to dry-hot events was 10.18% (95% confidence interval (CI): 8.93%, 11.45%), which was higher than that of wet-hot events (ER = 3.21%, 95% CI: 0.59%, 5.89%). The attributable fraction (AF) of mortality attributed to dry-hot events was 10.00% (95% CI: 9.50%, 10.72%) with higher burden for females, older people, central China, cardiovascular diseases and urban city. While for wet-hot events, AF was much lower (3.31%, 95% CI: 2.60%, 4.30%). We also found that high temperature and low relative humidity had synergistic additive interaction on mortality risk. Conclusion: Dry-hot events may have a higher risk of mortality than wet-hot events, and the joint effect of high temperature and low relative humidity may be greater than the sum of their individual effects.
Published: 2023
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11. Mortality Rate of Lymphoma in China, 2013–2020

Author: Weiping Liu, Jinlei Qi, Jiangmei Liu, Yuqin Song, Lijun Wang, Maigeng Zhou, Jun Ma, and Jun Zhu
Subjects: lymphoma, Hodgkin disease, non-Hodgkin lymphoma, epidemiology, mortality, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Lymphoma is a malignant disease that threatens human health and imposes a significant burden on the society burden; however, there are limited accurate mortality data on lymphoma in China. The present study aimed to analyse lymphoma-associated mortality at the national and provincial levels in mainland China. Mortality data of lymphoma was extracted from the disease surveillance system of the Chinese Center for Disease Control and Prevention. Mortality was represented by the number of deaths, crude mortality rate, and age-standardized mortality rate. Temporal trends in mortality rates were examined using the fitting joinpoint models. Lymphoma accounted for 31,225 deaths in 2020, of which 1,838 and 29,387 were due to Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), respectively. The age-standardized mortality rate per 100,000 population was 1.76 for lymphoma, 0.10 for HL, and 1.66 for NHL. The mortality rate increased with age, reaching a peak in the age group of 80–84 years for HL and over 85 years for NHL. Moreover, the death risk due to lymphoma was approximately 1.5–2 times greater in males than in females in all age groups. The mortality rate was higher in eastern China than in central and western China, indicating a heterogeneous distribution at the provincial level. During 2013–2020, the mortality rate of lymphoma decreased by 1.85% (−22.94% for HL and −0.14% for NHL). In conclusion, the mortality of lymphoma varied by sex, age, and regions, which highlighted the need of establish differentiated strategy for disease control and prevention.
Published: 2022
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12. The burden of oral cancer in China, 1990–2017: an analysis for the Global Burden of Disease, Injuries, and Risk Factors Study 2017

Author: Yang Yang, Maigeng Zhou, Xinying Zeng, and Chunxiao Wang
Subjects: Oral cancer, Incidence, Mortality, DALY, China, Disease burden, Dentistry, RK1-715
Abstract: Abstract 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.
Published: 2021
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13. Substantial health benefits of strengthening guidelines on indoor fine particulate matter in China

Author: Yang Xie, Ying Wang, Yichi Zhang, Wenhong Fan, Zhaomin Dong, Peng Yin, and Maigeng Zhou
Subjects: PM2.5, Health Implication, Air pollution, Mortality, 2035, Environmental sciences, GE1-350
Abstract: In 2020, China for the first time developed guidelines for indoor fine particulate matter (PM2.5) in the draft document of indoor air standards, while the associated health implication remains unclear. Here, we first estimated the PM2.5 associated premature deaths was 965 thousand in 2019, with the indoor PM2.5 of outdoor origin accounting for 72.9%. Then, we examined the dynamic mortalities under a scenario matrix of 36 conditions, by incorporating various shared socioeconomic pathways in 2035, the draft guidelines and the contributions of ambient PM2.5 to indoor exposure. Although it may be improbable, the averages of premature deaths associated with ambient PM2.5 will be 1018–1361 thousand in 2035 when the worst-case scenario of guidelines mandating a yearly (rather than daily) indoor PM2.5 concentration of 75 µg/m3, compared to the averages of estimation were 816–1304 thousand for better-case scenario of 35 µg/m3. Under these scenarios, the increase in the number of premature deaths was mainly driven by population aging. In 2035, an ambitious target of yearly indoor PM2.5 concentrations of 15 µg/m3 is anticipated to reduce the number of deaths associated with ambient PM2.5 by approximately 25% of the 2019 baseline. Stricter guidelines to restrict the indoor PM2.5 concentrations are recommended to mitigate the mortality risk in the future.
Published: 2022
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14. Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack

Author: Runhua Zhang, Qin Xu, Anxin Wang, Yong Jiang, Xia Meng, Maigeng Zhou, Yongjun Wang, and Gaifen Liu
Subjects: anemia, functional outcome, hemoglobin, mortality, recurrence, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.
Published: 2021
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15. Hourly temperature variability and mortality in 31 major Chinese cities: Effect modification by individual characteristics, season and temperature zone

Author: Zhou Yang, Jun Yang, Maigeng Zhou, Peng Yin, Zhaoyue Chen, Qi Zhao, Kejia Hu, Qiyong Liu, and Chun-Quan Ou
Subjects: Hourly temperature variability, Mortality, Attributable fraction, Effect modifier, China, Environmental sciences, GE1-350
Abstract: Background: In the context of ongoing climate change, temperature variability (TV) has been considered as an important trigger of death. However, evidence of association between mortality and hourly temperature variability (HTV) is scarce at the multi-city level, and the time window of health effects of HTV is lack of investigation. This study aims at quantifying the mortality risk and burden of HTV and exploring subpopulations susceptible to HTV from a large-scale multi-city perspective. Methods: Data on daily number of deaths and meteorology were collected for 31 Chinese major cities during 2007–2013. HTV was calculated as the standard deviation of hourly temperature within a few days. The optimal exposure period of HTV was chosen according to multiple scientific criteria. A quasi-Poisson regression combined with distributed lag nonlinear model was used to assess the city-specific HTV-mortality associations. Then, meta-analysis was further applied to pool city-specific effect estimates. Finally, we calculated the fraction of mortality attributable to HTV. Stratification analyses were conducted by individual characteristics (i.e. age, sex, and educational attainment), season, and region. Results: HTV calculated in a relatively long-time window like 18 d (HTV0–17) could capture the impact of HTV adequately. Per 1 °C raise of HTV0–17 associated with 1.38% (95%CI: 0.77, 1.99) increase of non-accidental mortality. During the study period, 5.47% (95%CI: 1.06, 9.64) of non-accidental mortality could be attributed to HTV. The females, the elderly, and individuals with low education level were more susceptible to HTV than their counterparts, respectively. Moreover, a stronger HTV-mortality association was observed in individuals who live in warmer season and temperature zone. Conclusion: HTV is associated with a considerable mortality burden, which may be modified by season, geographic and individual-level factors. Our findings highlight the practical importance of establishing early warning systems and promoting health education to mitigate the impacts of temperature variability.
Published: 2021
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16. Disease burden and attributable risk factors of respiratory infections in China from 1990 to 2019

Author: Zengliang Ruan, Jinlei Qi, Zhengmin (Min) Qian, Maigeng Zhou, Yin Yang, Shiyu Zhang, Michael G. Vaughn, Morgan H. LeBaige, Peng Yin, and Hualiang Lin
Subjects: Respiratory infection, GBD 2019, Incidence, Mortality, Disability-adjusted life years, Public aspects of medicine, RA1-1270
Abstract: Background: There was lack of data on the burdens and trends of upper and lower respiratory infections (URIs and LRIs) over the past three decades in China. Methods: We estimated the incidence, mortality, and disability-adjusted life years (DALYs) due to upper and lower respiratory infections (URIs and LRIs) and attributable risk factors in China by a systematic analysis of the Global Burden of Disease 2019 study. Incidence, mortality, and DALYs were stratified by sex, age, and province. Risk factors for respiratory infections were analyzed from exposure data. Findings: The age-standardized incidence rates of URIs and LRIs were 179,077 and 3926 per 100,000 persons in 2019, with a 7•52% and 35•07% decrease from 1990, respectively. Moreover, 2801 and 185,264 persons died of URIs and LRIs in 2019, respectively. DALYs for URIs and LRIs also decreased from 1,516,727 in 1990 to 928,617 in 2019 and from 38,278,504 in 1990 to 4,020,676 in 2019. The burden of URIs and LRIs were generally similar in males and females, but relatively higher in the new-borns and the elderly. Child malnutrition and low birth weight were the most important cause of age-standardized DALYs of LRIs and URIs, respectively. Interpretation: Future URI and LRI prevention strategies should focus on the maternal and child health, air pollution, and tobacco control, especially in young children and the elderly population. Funding: National Key R&D Program of China (2018YFA0606200); National Natural Science Foundation of China (82041021); Fundamental Research Funds for the Central Universities (20ykpy86) and Guangdong Basic and Applied Basic Research Foundation (2019A1515110003); Bill & Melinda Gates Foundation (No.: INV-006371).
Published: 2021
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17. Mortality of lymphoma and myeloma in China, 2004–2017: an observational study

Author: Weiping Liu, Jiangmei Liu, Yuqin Song, Xiaopei Wang, Maigeng Zhou, Lijun Wang, Jun Ma, Jun Zhu, and Union for China Leukemia Investigators of the Chinese Society of Clinical Oncology, Union for China Lymphoma Investigators of the Chinese Society of Clinical Oncology
Subjects: Lymphoma, Multiple myeloma, Mortality, Epidemiology, Diseases of the blood and blood-forming organs, RC633-647.5, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract: Abstract Background There is a dearth of accurate information about patterns of mortality of lymphoid neoplasms and temporal trends in China. In this nationwide mortality study, we aimed to assess the mortality of lymphoma and myeloma in 2017 and the changes in the trend from 2004 to 2016. Methods Death certificate data obtained from the Chinese Center for Disease Control and Prevention’s disease surveillance points system (CDC-DSP) and population data from the National Bureau of Statistics of China were used in this study. We described the mortality of lymphoma and myeloma in 2017 by age group, sex, residence, and region and evaluated the temporal trend from 2004 to 2016 using joinpoint regression. Results An estimated 52,000 deaths associated with lymphoma and myeloma occurred in 2017. The age-standardized mortality rate China (ASMRC) and age-standardized mortality rate worldwide (ASMRW) per 100,000 were 3.74 and 2.60, respectively. Males had higher ASMRC than females (4.54 vs. 2.91 per 100,000). The ASMRC in urban areas was significantly higher than that in rural areas (4.35 vs. 3.47 per 100,000). The age-specific mortality rate showed an upward trend with age and reached a maximum in the age group of over 85 years. In terms of regional variation, Eastern China had the highest mortality rate (3.43/100,000), followed by Central China (3.10/100,000) and Western China (3.02/100,000). The mortality rates of lymphoma and myeloma increased annually by 4.5% during the period 2004–2016, with a significant rapid upward trend in rural areas since 2007. Conclusions The mortality of lymphoma and myeloma increased in China from 2004 to 2017. The rapid increase in disease burden in rural areas highlights new challenges for disease prevention and control strategies.
Published: 2019
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18. Mortality effects of heat waves vary by age and area: a multi-area study in China

Author: Lingyan Zhang, Zhao Zhang, Tao Ye, Maigeng Zhou, Chenzhi Wang, Peng Yin, and Bin Hou
Subjects: Mortality, Heat wave, Population vulnerability, Probabilistic risk assessment, China, Industrial medicine. Industrial hygiene, RC963-969, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Many studies have reported an increased mortality risk from heat waves comparing with non-heat wave days. However, how much the mortality rate change with the heat intensity―vulnerability curve―is still unknown. Such unknown information makes the related managers impossible to assess scientifically life losses from heat waves, consequently fail in conducting suitable integrated risk management measures. Methods We used the heat wave intensity index (HWII) to characterize quantitatively the heat waves, then applied a distributed lag non-linear model to explore the area-specific definition of heat wave, and developed the vulnerability models on the relationships between HWII and mortality by age and by area. Finally, Monte Carlo method was run to assess and compare the event-based probabilistic heat wave risk during the periods of 1971–2015 and 2051–2095. Results We found a localized definition of heat wave for each corresponding area based on the minimum AIC (Akaike information criterion). Under the local heat wave events, the expected life loss during 1971–2015 does distinguish across areas, and decreases consistently in the order of WZ Chongqing, PK Nanjing and YX Guangzhou for each age group. More specifically, for the elders (≥65), the average annual loss (AAL) (and 95% confidence interval) would be 61.3 (30.6–91.9), 38 (3.8–72.2) and 18.7 (7.3–30) deaths per million people. With two stresses from warming and aging in future China, the predicted average AAL of the elders under four Representative Carbon Pathways (2.6, 4.5, 6.0, and 8.5) during 2051–2095 would be 2460, 1675, 465 deaths per million for PK Nanjing, YX Guangzhou and WZ Chongqing, respectively, approximately becoming 8~ 90 times of the AAL during 1971–2015. Conclusion This study found that the non-linear HWII–mortality relationships vary by age and area. The heat wave mortality losses are closely associated with the social-economic level. With the increasing extreme climatic events and a rapid aging trend in China, our findings can provide guidance for policy-makers to take appropriate regional adaptive measures to reduce health risks in China.
Published: 2018
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19. Burden of Ischaemic heart disease and attributable risk factors in China from 1990 to 2015: findings from the global burden of disease 2015 study

Author: Ganshen Zhang, Chuanhua Yu, Maigeng Zhou, Lu Wang, Yunquan Zhang, and Lisha Luo
Subjects: Ischaemic heart disease, Mortality, Disability-adjusted life years, Risk factors, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background Ischaemic heart disease (IHD) is a major barrier to sustainable human development, but its health burden and geographic distribution among provinces of China remain unclear. This study aimed to estimate IHD burden in provinces of China, and attributable to risk factors from 1990 to 2015. Methods Data were collected from the Global Burden of Disease 2015 Study, which evaluated IHD burden and attributable risk factors using deaths and disability-adjusted life years (DALYs). Statistical models including cause of death ensemble modelling, Bayesian meta-regression analysis, and comparative risk assessment approaches were applied to reduce bias and produce comprehensive results of IHD deaths, DALYs and attributable risks. The 95% uncertainty intervals (UIs) were calculated and reported for mortality and DALYs. Results The age-standardised death rate per 100,000 people increased by 13.3% from 101.3 (95%UI: 95.3–107.5) to 114.8 (95%UI: 109.8–120.1) from 1990 to 2015 in China, whereas the age-standardised DALY rate declined 3.9% to 1760.2 per 100,000 people (95%UI: 1671.6–1864.3). In 2015, the age-standardised death rate per 100,000 people was the highest in Heilongjiang (187.4, 95%UI: 161.6–217.5) and the lowest in Shanghai (44.2, 95%UI: 37.0–53.1), and the age-standardised DALY rate per 100,000 people was the highest in Xinjiang (3040.8, 95%UI: 2488.8–3735.4) and the lowest in Shanghai (524.4, 95%UI: 434.7–638.4). Geographically, the age-standardised death and DALY rates for southern provinces were lower than northern provinces, especially in southeastern coastal provinces. 95.3% of the IHD burden in China was attributable to environmental, behavioural and metabolic risk factors. The five leading IHD risks in 2015 were high systolic blood pressure, high total cholesterol, diet high in sodium, diet low in whole grains, and smoking. Conclusions Population growth and ageing has led to a steady increase in the IHD burden. Regional disparities in IHD burden were observed in provinces of China. The distribution characteristics of IHD burden provide guidance for decision makers to formulate targeted preventive policies and interventions.
Published: 2018
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20. Reduced Kidney Function, Albuminuria, and Risks for All-cause and Cardiovascular Mortality in China: A Population-based Cohort Study

Author: Jinwei Wang, Fang Wang, Shiwei Liu, Maigeng Zhou, Luxia Zhang, and Minghui Zhao
Subjects: Cardiovascular diseases, China, Chronic kidney disease, Glomerular filtration rate, Mortality, Urinary albumin-to-creatinine ratio, Diseases of the genitourinary system. Urology, RC870-923
Abstract: Abstract Background Previous studies have indicated that reduced kidney function and albuminuria are associated with increased risk of mortality and adverse cardiovascular outcomes, however, the evidence from the Asian population is limited. We investigated the association between the indicators of chronic kidney disease (CKD) and all-cause mortality, as well as cardiovascular mortality among a general population in China. Methods We conducted an observational study among 47,204 Chinese adults, from a cross-sectional survey, whose survival status is identified through December 31, 2013. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) were used as indicators of CKD. We determined the rates of all-cause and cardiovascular mortality. Results The incidence rates for both all-cause and cardiovascular mortality increased with the advanced stages of reduced eGFR or elevated ACR. Elevated ACR levels were found to be significantly associated with increased risk of both all-cause and cardiovascular mortality, as shown in the Cox proportional hazards regression model. The multivariable adjusted hazard ratios (HR) associated with all-cause mortality were 1.26 (95% confidence interval [CI]: 1.04–1.53) for those with ACR 30–299 mg/g and 2.07 (95% CI: 1.40–3.04) with ACR ≥ 300 mg/g, compared to those with ACR
Published: 2017
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21. Trends in Mortality of Cirrhosis in China: An Analysis of the China Death Surveillance Database from 2008 to 2020.

Author: Xiaoxiao Wang, Huixin Liu, Jinlei Qi, Lijun Wang, Peng Yin, Feng Liu, Lai Wei, Yu Wang, Maigeng Zhou, and Huiying Rao
Subjects: FATTY liver, CHRONIC active hepatitis, NON-alcoholic fatty liver disease, CHRONIC hepatitis B, YOUNG adults, HEPATITIS C
Published: 2024
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22. Trend of nasopharyngeal carcinoma mortality and years of life lost in China and its provinces from 2005 to 2020

Author: Zheng Long, Wei Wang, Wei Liu, Feixue Wang, Shidi Meng, Jiangmei Liu, Yunning Liu, Jinlei Qi, Lijun Wang, Maigeng Zhou, and Peng Yin
Subjects: Male, Aging, China, Cancer Research, Nasopharyngeal Carcinoma, Oncology, Humans, Female, Nasopharyngeal Neoplasms, Public Health, Mortality
Abstract: 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.
Published: 2022

23. Mortality and years of life lost of cardiovascular diseases in China, 2005–2020: Empirical evidence from national mortality surveillance system

Author: Lin Lin, Jinlei Qi, Jinling You, Yunning Liu, Feixue Wang, Peng Yin, Jiangmei Liu, Lijun Wang, Wei Wang, Shidi Meng, and Maigeng Zhou
Subjects: China, education.field_of_study, Population ageing, Mortality, Premature, business.industry, Mortality rate, Population, Disease, medicine.disease, Hypertensive heart disease, Years of potential life lost, Cost of Illness, Cardiovascular Diseases, Risk Factors, Environmental health, Humans, Medicine, cardiovascular diseases, Mortality, Cardiology and Cardiovascular Medicine, business, education, Stroke, Cause of death
Abstract: 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.
Published: 2021

24. The burden of oral cancer in China, 1990–2017: an analysis for the Global Burden of Disease, Injuries, and Risk Factors Study 2017

Author: Chunxiao Wang, Yang Yang, Maigeng Zhou, and Xinying Zeng
Subjects: Burden of disease, Male, medicine.medical_specialty, China, Global Burden of Disease, 03 medical and health sciences, 0302 clinical medicine, Intervention measures, Risk Factors, medicine, Humans, Disabled Persons, 030212 general & internal medicine, Mortality, General Dentistry, Disease burden, DALY, business.industry, Public health, Incidence (epidemiology), Oral cancer, Incidence, Cancer, medicine.disease, lcsh:RK1-715, 030220 oncology & carcinogenesis, lcsh:Dentistry, Oral and maxillofacial surgery, Hong Kong, Female, Mouth Neoplasms, Quality-Adjusted Life Years, business, Demography, Research Article
Abstract: 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.
Published: 2021

25. Burden of colorectal cancer attributable to diet low in milk in China, 1990–2017: findings from the global burden of disease study 2017

Author: Yuhuan Gao, Man Li, Xin-na Li, J M Liu, W B Guo, Maigeng Zhou, Zhuo Qun Wang, Lantong Zhang, and Yunfeng Zhao
Subjects: Adult, Male, 0301 basic medicine, Burden of disease, China, medicine.medical_specialty, Colorectal cancer, Population, Medicine (miscellaneous), 030209 endocrinology & metabolism, Recommended Dietary Allowances, 03 medical and health sciences, Spatio-Temporal Analysis, 0302 clinical medicine, Cost of Illness, medicine, Animals, Humans, Mortality, education, Disease burden, Aged, Aged, 80 and over, education.field_of_study, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Public health, Disability-Adjusted Life Years, Middle Aged, medicine.disease, Diet, Weak correlation, Milk, Attributable risk, Female, Colorectal Neoplasms, business, Demography
Abstract: 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.
Published: 2020

26. Association between Cold Spells and Mortality Risk and Burden: A Nationwide Study in China

Author: Jian Lei, Renjie Chen, Peng Yin, Xia Meng, Lina Zhang, Cong Liu, Yang Qiu, John S. Ji, Haidong Kan, and Maigeng Zhou
Subjects: Cold Temperature, China, Hot Temperature, Health, Toxicology and Mutagenesis, Temperature, Public Health, Environmental and Occupational Health, Humans, Seasons, Cities, Mortality, Aged
Abstract: Few multicity studies have evaluated the association between cold spells and mortality risk and burden.We aimed to estimate the association between cold spells and cause-specific mortality and to evaluate the mortality burden in China.We conducted a time-series analysis with a nationally representative Disease Surveillance Points System database during the cool seasons spanning from 2013 to 2015 in 272 Chinese cities. We used 12 cold-spell definitions and overdispersed generalized additive models with distributed lag models to estimate the city-specific cumulative association of cold spells over lags of 0-28 d. We controlled for the nonlinear and lagged effects of cold temperature over 0-28 d to evaluate the added effect estimates of cold spell. We also quantified the nationwide mortality burden and pooled the estimated association at national and different climatic levels with meta-regression models.For the cold-spell definition of daily mean temperatures ofOur study provides evidence for the significant relative risks of non-accidental, cardiovascular, and respiratory mortality associated with cold spells. The findings on vulnerable populations and differential risks in different climatic zones may help establish region-specific forecasting systems against the hazardous impact of cold spells. https://doi.org/10.1289/EHP9284.
Published: 2022

27. The disease burden attributable to 18 occupational risks in China: an analysis for the global burden of disease study 2017

Author: Shicheng Yu, Jinling You, Lijun Wang, Xinying Zeng, Zhenping Zhao, Peng Yin, Jiangmei Liu, Jie Li, Maigeng Zhou, Yunning Liu, Haidong Wang, and Xiao Zhang
Subjects: Burden of disease, medicine.medical_specialty, China, Health, Toxicology and Mutagenesis, Psychological intervention, 010501 environmental sciences, 01 natural sciences, Occupational safety and health, Global Burden of Disease, 03 medical and health sciences, lcsh:RC963-969, 0302 clinical medicine, Risk Factors, Environmental health, Occupational Exposure, medicine, 030212 general & internal medicine, Mortality, Socioeconomic status, Disease burden, Occupational Health, 0105 earth and related environmental sciences, Geography, business.industry, Public health, Mortality rate, Research, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Risk exposure, Death, Socioeconomic Factors, Attributable burden, lcsh:Industrial medicine. Industrial hygiene, Quality-Adjusted Life Years, Occupational risk, business
Abstract: Background China has more than 18% of the global population and over 770 million workers. However, the burden of disease attributable to occupational risks is unavailable in China. We aimed to estimate the burden of disease attributable to occupational exposures at provincial levels from 1990 to 2017. Methods We estimated the summary exposure values (SEVs), deaths and disability-adjusted life years (DALYs) attributable to occupational risk factors in China from 1990 to 2017, based on Global Burden of Disease Study (GBD) 2017. There were 18 occupational risks, 22 related causes, and 35 risk-outcome pairs included in this study. Meanwhile, we compared age-standardized death rates attributable to occupational risk factors in provinces of China by socio-demographic index (SDI). Results The SEVs of most occupational risks increased from 1990 to 2017. There were 323,833 (95% UI 283,780 - 369,061) deaths and 14,060,210 (12,022,974 - 16,125,763) DALYs attributable to total occupational risks in China, which were 27.9 and 22.1% of corresponding global levels, respectively. For attributable deaths, major risks came from occupational particulate matter, gases, and fumes (PGFs), and for the attributable DALYs, from occupational injuries. The attributable burden was higher in males than in females. Compared with high SDI provinces, low SDI provinces, especially Western China, had higher death rates attributable to total occupational risks, occupational PGFs, and occupational injuries. Conclusion Occupational risks contribute to a huge disease burden in China. The attributable burden is higher in males, and in less developed provinces of Western China, reflecting differences in risk exposure, socioeconomic conditions, and type of jobs. Our study highlights the need for further research and focused policy interventions on the health of workers especially for less developed provinces in China to reduce occupational health losses effectively.
Published: 2020

28. Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack

Author: Xia Meng, Yong Jiang, Qin Xu, Maigeng Zhou, Runhua Zhang, Yongjun Wang, Anxin Wang, and Gaifen Liu
Subjects: medicine.medical_specialty, Anemia, Risk Assessment, functional outcome, Hemoglobins, Recurrence, Internal medicine, medicine, Risk of mortality, Diseases of the circulatory (Cardiovascular) system, Humans, Mortality, Stroke, Ischemic Stroke, business.industry, Proportional hazards model, Hazard ratio, Odds ratio, hemoglobin, medicine.disease, anemia, stroke, Abnormal hemoglobin, Functional Status, Treatment Outcome, Ischemic Attack, Transient, RC666-701, Cardiology, Hemoglobin, Cardiology and Cardiovascular Medicine, business
Abstract: Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.
Published: 2021

29. Future injury mortality burden attributable to compound hot extremes will significantly increase in China

Author: Liying, Luo, Fangfang, Zeng, Guoxia, Bai, Weiwei, Gong, Zhoupeng, Ren, Jianxiong, Hu, Guanhao, He, Heng, Shi, Ziqiang, Lin, Tao, Liu, Peng, Yin, Mingfang, Qin, Zhulin, Hou, Ruilin, Meng, Chunliang, Zhou, Xiaomei, Dong, Zhuoma, Pingcuo, Yize, Xiao, Min, Yu, Biao, Huang, Xiaojun, Xu, Lifeng, Lin, Jianpeng, Xiao, Jieming, Zhong, Donghui, Jin, Yajie, Li, Cangjue, Gama, Peng, Xiong, Yiqing, Xu, Lingshuang, Lv, Weilin, Zeng, Xing, Li, Maigeng, Zhou, Cunrui, Huang, and Wenjun, Ma
Subjects: Male, China, Cross-Over Studies, Hot Temperature, Environmental Engineering, Climate Change, Pollution, Humans, Wounds and Injuries, Environmental Chemistry, Female, Mortality, Waste Management and Disposal, Aged, Forecasting
Abstract: As climate change, compound hot extremes (CHEs), daytime and nighttime persistent hot extremes, are projected to become much more frequent and intense, which may pose a serious threat to human health. However, evidence on the impact of CHEs on injury is rare.We collected injury death data and daily meteorological data from six Chinese provinces during 2013-2018. A time-stratified case-crossover design with two-stage analytic approach was applied to assess the associations of CHEs with injury mortality by intention, mechanism, age and gender. Using the projected daily temperatures of five General Circulation Models (GCMs), we projected the frequency of CHEs and CHEs-attributable mortality burden of injury under three Representative Concentration Pathway (RCP) scenarios.CHEs were significantly associated with increased injury mortality risk (RR = 1.14, 95%CI: 1.09-1.19), with strong effects on unintentional injuries (RR = 1.16, 95%CI:1.11,1.22) and intentional injuries (RR = 1.11, 95%CI:0.99,1.25). Female (RR = 1.21,95%CI: 1.13-1.29) and the elderly (RR = 1.30, 95%CI: 1.22-1.39) were more susceptible to CHEs. Both the frequency and injury mortality burden of CHEs showed a steep rising trend under RCP8.5 scenario, with a 7.37-fold and 8.22-fold increase respectively, by the end of the century, especially in southern, eastern, central and northwestern China.CHEs were associated with increased injury mortality risk, and the CHEs-attributable injury mortality burden was projected to aggravate substantially in the future as global warming. It is urgent to develop targeted adaptation policies to alleviate the health burden of CHEs.
Published: 2022

30. Trend of Mortality and Years of Life Lost Due to Chronic Obstructive Pulmonary Disease in China and Its Provinces, 2005-2020

Author: Wei Liu, Lijun Wang, Shidi Meng, Peng Yin, Jiangmei Liu, Zheng Long, Yunning Liu, Wei Wang, Feixue Wang, Maigeng Zhou, Lin Lin, Jinlei Qi, and Jinling You
Subjects: Population ageing, medicine.medical_specialty, Aging, China, Pulmonary disease, International Journal of Chronic Obstructive Pulmonary Disease, Pulmonary Disease, Chronic Obstructive, YLL, medicine, Population growth, Humans, COPD, Mortality, Original Research, business.industry, Mortality, Premature, Mortality rate, Public health, General Medicine, medicine.disease, respiratory tract diseases, Years of potential life lost, Quality of Life, business, Demography
Abstract: Wei Liu,&ast; Wei Wang,&ast; 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, Peopleâs Republic of China&ast;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, Peopleâs 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 2005â 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 2005â 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 2005â 2020, the age-standardized mortality rate decreased in all provinces (except for Tibet) with the largest decline in Jilin (â 77.8%), Henan (â 68.4%) and Fujian (â 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 (â 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
Published: 2021

31. Disease burden and attributable risk factors of respiratory infections in China from 1990 to 2019

Author: Hualiang Lin, Peng Yin, Michael G. Vaughn, Zengliang Ruan, Morgan H. LeBaige, Zhengmin Min Qian, Yin Yang, Jinlei Qi, Shiyu Zhang, and Maigeng Zhou
Subjects: GBD 2019, Disability-adjusted life years, Environmental health, Respiratory infection, Internal Medicine, medicine, Mortality, China, Disease burden, business.industry, Health Policy, Incidence (epidemiology), Incidence, Tobacco control, Public Health, Environmental and Occupational Health, Obstetrics and Gynecology, medicine.disease, Psychiatry and Mental health, Malnutrition, Low birth weight, Infectious Diseases, Pediatrics, Perinatology and Child Health, Attributable risk, Geriatrics and Gerontology, medicine.symptom, Public aspects of medicine, RA1-1270, business, Research Paper
Abstract: Background: There was lack of data on the burdens and trends of upper and lower respiratory infections (URIs and LRIs) over the past three decades in China. Methods: We estimated the incidence, mortality, and disability-adjusted life years (DALYs) due to upper and lower respiratory infections (URIs and LRIs) and attributable risk factors in China by a systematic analysis of the Global Burden of Disease 2019 study. Incidence, mortality, and DALYs were stratified by sex, age, and province. Risk factors for respiratory infections were analyzed from exposure data. Findings: The age-standardized incidence rates of URIs and LRIs were 179,077 and 3926 per 100,000 persons in 2019, with a 7•52% and 35•07% decrease from 1990, respectively. Moreover, 2801 and 185,264 persons died of URIs and LRIs in 2019, respectively. DALYs for URIs and LRIs also decreased from 1,516,727 in 1990 to 928,617 in 2019 and from 38,278,504 in 1990 to 4,020,676 in 2019. The burden of URIs and LRIs were generally similar in males and females, but relatively higher in the new-borns and the elderly. Child malnutrition and low birth weight were the most important cause of age-standardized DALYs of LRIs and URIs, respectively. Interpretation: Future URI and LRI prevention strategies should focus on the maternal and child health, air pollution, and tobacco control, especially in young children and the elderly population. Funding: National Key R&D Program of China (2018YFA0606200); National Natural Science Foundation of China (82041021); Fundamental Research Funds for the Central Universities (20ykpy86) and Guangdong Basic and Applied Basic Research Foundation (2019A1515110003); Bill & Melinda Gates Foundation (No.: INV-006371).
Published: 2021

32. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019

Author: Miao Cai, Rui Li, Chuming Yan, Yuan Wang, Hualiang Lin, Yin Yang, Peng Yin, Mohsen Naghavi, Zhengmin Qian, Qingfeng Ma, Maigeng Zhou, Chongjian Wang, Michael G. Vaughn, Zilong Zhang, Stephen Edward McMillin, Lijun Wang, Simon I. Hay, and Yi Ren
Subjects: Male, China, Population, Prevalence, Global Burden of Disease, Cost of Illness, Risk Factors, Environmental health, medicine, Humans, Mortality, education, Stroke, Disease burden, education.field_of_study, Population Health, business.industry, Mortality rate, Incidence (epidemiology), Incidence, Public Health, Environmental and Occupational Health, Disability-Adjusted Life Years, medicine.disease, Attributable risk, Female, Risk assessment, business
Abstract: Summary Background Understanding the temporal trend of the disease burden of stroke and its attributable risk factors in China, especially at provincial levels, is important for effective prevention strategies and improvement. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is to investigate the disease burden of stroke and its risk factors at national and provincial levels in China from 1990 to 2019. Methods Following the methodology in the GBD 2019, the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of stroke cases in the Chinese population were estimated by sex, age, year, stroke subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage), and across 33 provincial administrative units in China from 1990 to 2019. Attributable mortality and DALYs of underlying risk factors were calculated by a comparative risk assessment. Findings In 2019, there were 3·94 million (95% uncertainty interval 3·43–4·58) new stroke cases in China. The incidence rate of stroke increased by 86·0% (73·2–99·0) from 1990, reaching 276·7 (241·3–322·0) per 100 000 population in 2019. The age-standardised incidence rate declined by 9·3% (3·3–15·5) from 1990 to 2019. Among 28·76 million (25·60–32·21) prevalent cases of stroke in 2019, 24·18 million (20·80–27·87) were ischaemic stroke, 4·36 million (3·69–5·05) were intracerebral haemorrhage, and 1·58 million (1·32–1·91) were subarachnoid haemorrhage. The prevalence rate increased by 106·0% (93·7–118·8) and age-standardised prevalence rate increased by 13·2% (7·7–19·1) from 1990 to 2019. In 2019, there were 2·19 million (1·89–2·51) deaths and 45·9 million (39·8–52·3) DALYs due to stroke. The mortality rate increased by 32·3% (8·6–59·0) from 1990 to 2019. Over the same period, the age-standardised mortality rate decreased by 39·8% (28·6–50·7) and the DALY rate decreased by 41·6% (30·7–50·9). High systolic blood pressure, ambient particulate matter pollution exposure, smoking, and diet high in sodium were four major risk factors for stroke burden in 2019. Moreover, we found marked differences of stroke burden and attributable risk factors across provinces in China from 1990 to 2019. Interpretation The disease burden of stroke is still severe in China, although the age-standardised incidence and mortality rates have decreased since 1990. The stroke burden in China might be reduced through blood pressure management, lifestyle interventions, and air pollution control. Moreover, because substantial heterogeneity of stroke burden existed in different provinces, improved health care is needed in provinces with heavy stroke burden. Funding National Key Research and Development Program of China and Taikang Yicai Public Health and Epidemic Control Fund.
Published: 2021

33. Cold spell and mortality in 31 Chinese capital cities: Definitions, vulnerability and implications

Author: Jinjian Chen, Chun-Quan Ou, Qiyong Liu, Xiuping Song, Jun Yang, Boguang Wang, Peng Yin, Zhao-Yue Chen, Maigeng Zhou, and Jiangmei Liu
Subjects: Adult, Male, Risk, Distributed lag, China, Percentile, Adolescent, 010504 meteorology & atmospheric sciences, Lag, Developing country, Context (language use), 010501 environmental sciences, 01 natural sciences, Young Adult, Asian People, Humans, Cities, Mortality, Child, lcsh:Environmental sciences, Aged, 0105 earth and related environmental sciences, General Environmental Science, lcsh:GE1-350, Infant, Newborn, Infant, Regression analysis, Middle Aged, Random effects model, Cold Temperature, Geography, Child, Preschool, Relative risk, Female, Demography
Abstract: Background: In the context of global warming, most researches have been conducted on health influences of heat waves, with limited understanding of health impacts of cold spells, especially for developing countries. Methods: We collected daily mortality and meteorological data for 31 capital cities across China during the maximum period of 2007–2013. A quasi-Poisson regression model combined with a distributed lag non-linear model was used to estimate the short-term effects of cold spells on mortality in cold seasons (November to March). 19 definitions of cold spell were clearly compared, including three definitions from the China Meteorological Administration (CMA) and 16 definitions by combining two temperature indicators (daily minimum and mean temperature), two temperature thresholds (3rd and 5th percentile) and four durations of at least 2–5 days. Then, a random effect meta-analysis was applied to pool the effect estimates at national level. Furthermore, a stratified analysis was constructed to identify the vulnerable subpopulations to cold spells. Results: The definition, in which daily mean temperature falls below 5th percentile for at least two consecutive days, produced the optimum model fit performance. Generally, the mortality risk increased to the maximum after 3–6 days' exposure to cold spell and then leveled off in the next 3 weeks. The pooled relative risks (RR) of non-accidental mortality for cold spells were 1.03 (95% CI: 1.01–1.05), 1.27 (1.19–1.35) and 1.55 (1.40–1.70) at lag 0, lag 0–14 and lag 0–27 days, respectively. The greatest effect estimates of cold spells were found among total respiratory diseases and COPD, with RR of 1.88 (1.65–2.11) and 1.88 (1.58–2.19), respectively. The elderly, less-educated individuals and residents in southern China were more vulnerable to cold spells. Conclusion: There are remarkable mortality effects of cold spells, with effect estimates varying with the definition of cold spell and subpopulations. Using the official definition of cold spells may fail to capture the mortality risk associated with cold spells. These findings may facilitate the development of cold alert warning system and preventive actions to the vulnerable populations. Keywords: Cold spell, Definition, Cause-specific mortality, Vulnerable population, China
Published: 2019

34. Differentiating the effects of air pollution on daily mortality counts and years of life lost in six Chinese megacities

Author: Fei Tian, Jinlei Qi, Zhengmin Qian, Huan Li, Lijun Wang, Chongjian Wang, Sarah Dee Geiger, Stephen Edward McMillin, Peng Yin, Hualiang Lin, and Maigeng Zhou
Subjects: Air Pollutants, China, Environmental Engineering, Nitrogen Dioxide, Myocardial Ischemia, Environmental Exposure, Pollution, Stroke, Neuroblastoma, Pulmonary Disease, Chronic Obstructive, Air Pollution, Humans, Environmental Chemistry, Particulate Matter, Cities, Mortality, Waste Management and Disposal
Abstract: Ambient air pollution has been widely associated with increased mortality and years of life lost (YLL) from various diseases. However, no study has assessed that the effects of air pollution on overall YLL were due to increased number of mortalities or average YLL per death.We first conducted a time-series study from 2013 to 2016, covering six Chinese megacities. Generalized additive models with a Gaussian link were utilized to estimate the associations of fine particulate matter (PMA total of 1,586,741 deaths from non-accidental causes and 21,916,857 YLLs were recorded in the six cities, providing an average of 13.81 daily YLLs per death. Significant effects of PMOur study indicates observed associations between air pollution and YLL might be mainly induced by increasing mortality count, rather than increasing average life lost for each death. More relevant intervention should be performed to reduce the number of deaths due to air pollution.
Published: 2022

35. Short- and medium-term impacts of strict anti-contagion policies on non-COVID-19 mortality in China

Author: Jinlei, Qi, Dandan, Zhang, Xiang, Zhang, Tanakao, Takana, Yuhang, Pan, Peng, Yin, Jiangmei, Liu, Shuocen, Liu, George F, Gao, Guojun, He, and Maigeng, Zhou
Subjects: Adult, Male, China, Adolescent, Physical Distancing, Young Adult, Air Pollution, Cause of Death, Neoplasms, Humans, Registries, Mortality, Child, Respiratory Tract Infections, Aged, SARS-CoV-2, Accidents, Traffic, Infant, Newborn, Masks, COVID-19, Infant, Middle Aged, Cardiovascular Diseases, Child, Preschool, Communicable Disease Control, Wounds and Injuries, Female, Public Health
Abstract: The effects of coronavirus disease-19 (COVID-19) public health policies on non-COVID-19-related mortality are unclear. Here, using death registries based on 300 million Chinese people and a difference-in-differences design, we find that China's strict anti-contagion policies during the COVID-19 pandemic significantly reduced non-COVID-19 mortality outside Wuhan (by 4.6%). The health benefits persisted and became even greater after the measures were loosened: mortality was reduced by 12.5% in the medium term. Significant changes in people's behaviours (for example, wearing masks and practising social distancing) and reductions in air pollution and traffic accidents could have driven these results. We estimate that 54,000 lives could have been saved from non-COVID-19 causes during the 50 days of strict policies and 293,000 in the subsequent 115 days. The results suggest that virus countermeasures not only effectively controlled COVID-19 in China but also brought about unintended and substantial public health benefits.
Published: 2021

36. Hourly temperature variability and mortality in 31 major Chinese cities: Effect modification by individual characteristics, season and temperature zone

Author: Kejia Hu, Maigeng Zhou, Jun Yang, Qi Zhao, Zhou Yang, Qiyong Liu, Peng Yin, Chun-Quan Ou, and Zhao-Yue Chen
Subjects: Distributed lag, China, Hot Temperature, Low education, Climate Change, Climate change, Context (language use), Time windows, Humans, GE1-350, Cities, Mortality, General Environmental Science, Aged, Hourly temperature variability, Temperature, Attributable fraction, Effect modifier, Environmental sciences, Cold Temperature, Geography, Exposure period, Attributable risk, Female, Seasons, Effect modification, Demography
Abstract: Background In the context of ongoing climate change, temperature variability (TV) has been considered as an important trigger of death. However, evidence of association between mortality and hourly temperature variability (HTV) is scarce at the multi-city level, and the time window of health effects of HTV is lack of investigation. This study aims at quantifying the mortality risk and burden of HTV and exploring subpopulations susceptible to HTV from a large-scale multi-city perspective. Methods Data on daily number of deaths and meteorology were collected for 31 Chinese major cities during 2007–2013. HTV was calculated as the standard deviation of hourly temperature within a few days. The optimal exposure period of HTV was chosen according to multiple scientific criteria. A quasi-Poisson regression combined with distributed lag nonlinear model was used to assess the city-specific HTV-mortality associations. Then, meta-analysis was further applied to pool city-specific effect estimates. Finally, we calculated the fraction of mortality attributable to HTV. Stratification analyses were conducted by individual characteristics (i.e. age, sex, and educational attainment), season, and region. Results HTV calculated in a relatively long-time window like 18 d (HTV0–17) could capture the impact of HTV adequately. Per 1 °C raise of HTV0–17 associated with 1.38% (95%CI: 0.77, 1.99) increase of non-accidental mortality. During the study period, 5.47% (95%CI: 1.06, 9.64) of non-accidental mortality could be attributed to HTV. The females, the elderly, and individuals with low education level were more susceptible to HTV than their counterparts, respectively. Moreover, a stronger HTV-mortality association was observed in individuals who live in warmer season and temperature zone. Conclusion HTV is associated with a considerable mortality burden, which may be modified by season, geographic and individual-level factors. Our findings highlight the practical importance of establishing early warning systems and promoting health education to mitigate the impacts of temperature variability.
Published: 2020

37. Differentiating the effects of ambient fine and coarse particles on mortality from cardiopulmonary diseases: A nationwide multicity study

Author: Yunning Liu, Jinlei Qi, Fei Tian, Stephen Edward McMillin, Hualiang Lin, Peng Yin, Maigeng Zhou, Lijun Wang, Zengliang Ruan, Zhengmin Min Qian, Jiangmei Liu, and Chongjian Wang
Subjects: medicine.medical_specialty, China, 010504 meteorology & atmospheric sciences, Ischemic heart disease, Air pollution, Disease, 010501 environmental sciences, 01 natural sciences, complex mixtures, Inhalable particles, Internal medicine, medicine, Risk factor, Cities, Mortality, Adverse effect, lcsh:Environmental sciences, 0105 earth and related environmental sciences, General Environmental Science, Cardiopulmonary disease, lcsh:GE1-350, COPD, Air Pollutants, business.industry, Chronic obstructive pulmonary disease, Mortality burden, Guideline, Environmental Exposure, medicine.disease, Attributable risk, business, Particulate matter
Abstract: Background Both inhalable particles (PM10) and fine particles (PM2.5) are regulated in various countries mainly due to their adverse health effects. However, there is increasing evidence that PM2.5 might be responsible for these effects and coarse particles (PMc) plays little role in adverse health effects, if so, it might be not necessary to monitor PM10. Methods In this study, we conducted a time-series analysis using a generalized additive model to explore the effects of PM2.5, PMc, and PM10 on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in 96 Chinese cities during 2013–2016. The mortality number and attributable fraction were further estimated using the national air quality standard and WHO’s guideline as the reference. Results We observed significant effects of PM2.5 on IHD and COPD mortality; each 10 ug/m3 increase in lag01 PM2.5 was associated with a 0.26% (95% CI: 0.17%, 0.34%) increase in IHD mortality and a 0.19% (95% CI: 0.09%, 0.29%) increase in COPD mortality. We also found significant effects of PMc and PM10 on mortality from IHD and COPD, but the magnitudes of effects were weaker than those of PM2.5. The results were robust when adjusting for co-pollutants and altering model parameters. We further estimated that about 1.27% (95% CI: 0.29%, 2.30%) of IHD mortality and 1.25% (95% CI: 0.08%, 2.46%) of COPD mortality could be attributable to PM2.5 exposure using WHO’s guideline (25 ug/m3) as a reference, corresponding to 15,337 (95% CI: 3,375, 27,842) mortalities from IHD and 5,653 (95% CI: 379, 11,152) COPD mortalities in the 96 cities. Across all of China, almost fifty thousand cases of IHD mortality and twenty thousand cases of COPD mortality might be avoidable if the PM2.5 concentration declined to the WHO guideline. Conclusions Our study indicates that short-term exposure to PM2.5 could be an important risk factor of mortality from IHD and COPD, and substantial cardiopulmonary mortality could be avoidable by reducing daily PM2.5 concentrations. It is nonnegligible to consider the role of PMc in triggering in cardiopulmonary mortality. And it could be necessary to continue monitoring PM10 in the study regions due to the adverse effects of PMc.
Published: 2020

38. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. Parry, Maryam Ghadimi, Seyed-Mohammad Fereshtehnejad, Serge Resnikoff, Anna E. Torre, Vinod C Nayak, Jamileh Shadid, Susanne Breitner, Mohammad Khammarnia, Mathilde Touvier, Ensiyeh Jenabi, Hosna Janjani, Floriane Ausloos, Irmina Maria Michalek, Alexandra S. Boon-Dooley, Jessica A. Cruz, Syed Mohamed Aljunid, Abiodun M. Adeoye, André Faro, Bartosz Miazgowski, Jobert Richie Nansseu, Erin C Mullany, Giannina Ferrara, Martin McKee, Emmanuel Peprah, Oommen John, Reza Saeedi, Yasser Vasseghian, Dragos Virgil Davitoiu, Sarah Wulf Hanson, Yingxi Zhao, Omid Shafaat, Ali Rajabpour-Sanati, Farid Najafi, Ana Maria Mantilla Herrera, Fatemeh Rajati, Tarun Gupta, Łukasz Szumowski, Mohammed Ibrahim Mohialdeen Gubari, Peter Njenga Keiyoro, Dharmesh Kumar Lal, Zhi Jiang Zhang, Osayomwanbo Osarenotor, Tanvir M. Huda, Perminder S. Sachdev, Farhad Ghamari, Era Upadhyay, Vivek Kumar, Guoqing Hu, Vinay Nangia, Vladimir Andreevich Korshunov, Saeed Shahabi, Golnaz Heidari, Ashraf Nabhan, Robert C. Reiner, Aziz Rezapour, Justin J. Lang, Rakhi Dandona, Josephine W. Ngunjiri, Anna-Karin Danielsson, André Karch, Filippo Ariani, Ahmed Abdelalim, Masih Tajdini, Stefanos Tyrovolas, Mohamed Hsairi, Jae Il Shin, Jasvinder A. Singh, Meghan D. Mooney, Fiona B. Bennitt, Hesam Alizade, Segun Emmanuel Ibitoye, Pradhum Ram, Soraya Siabani, Evanson Z. Sambala, Reza Malekzadeh, Falk Schwendicke, Lalit Dandona, Masoud Moradi, Molly R Nixon, Roya Mirzaei, Rachel Feldman, Hosni Salem, Alberto L. García-Basteiro, Lorainne Tudor Car, Sharareh Eskandarieh, Ramesh Holla, Ritesh G. Menezes, Taraneh Yousefinezhadi, Hai Quang Pham, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Ali Bijani, Harvey Whiteford, Shanshan Li, Aleksandr Y. Aravkin, Joshua A. Salomon, Franz Castro, Lisa M. Force, Abdilahi Yousuf Yousuf, Mina Anjomshoa, Ken Takahashi, Maigeng Zhou, Telma Zahirian Moghadam, Maseer Khan, Irina Filip, Santi Martini, Randah R. Hamadeh, Somayeh Bohlouli, Joana Morgado-da-Costa, Tim Driscoll, Jingkai Wei, Hermann Brenner, Reza Rawassizadeh, Radoslaw Sierpinski, Saman Esmaeilnejad, Emmanuel Wandera Okunga, Marisa Freitas, Srikanta Banerjee, Feleke Mekonnen Demeke, Shahin Soltani, Naser Mohammad Gholi Mezerji, Reed J D Sorensen, Elena V. Gnedovskaya, Johan Ärnlöv, Ivo Rakovac, Reza Mohammadpourhodki, Hussain Jafari, Atte Meretoja, Yasir Waheed, Fahad Alanezi, Arya Haj-Mirzaian, Sezer Kisa, Jaifred Christian F. Lopez, Khalid F. Alhabib, Basema Saddik, Michael R. Phillips, Vishnu Renjith, Yafeng Wang, Kevan R. Polkinghorne, Liliana G Ciobanu, Jacek Jerzy Jozwiak, Gelin Xu, Richard C. Franklin, Junjie Wu, Thomas R. Hird, Mohammad Zamani, Diana Silva, Fotis Topouzis, Irena Ilic, Jeffrey D. Stanaway, Hadi Pourjafar, Huong Lan Thi Nguyen, Khaled Khatab, Ammas Siraj Mohammed, Ziyad Al-Aly, A. A. Fomenkov, Charlie Ashbaugh, Mowafa Househ, Paul I. Dargan, Endalkachew Worku Mengesha, Shaimaa I. El-Jaafary, Ernoiz Antriyandarti, Iffat Elbarazi, Dara K. Mohammad, Naznin Hossain, Reza Shirkoohi, João M. Furtado, Arash Ziapour, Morteza Jafarinia, M. Mofizul Islam, Anamika Pandey, Ahmed I. Hasaballah, Tanuj Kanchan, Lee Ling Lim, Muktar Omer Omer, Charles D.A. Wolfe, Ulrich O Mueller, Helen Bitew, V. Prakash, Fereshteh Mehri, Randall V. Martin, Claudiu Herteliu, Constance D. Pond, Min Jeong Shin, Morteza Oladnabi, Antonio Maria Borzì, Yousef Mohammad, Yuichiro Yano, Luke D. Knibbs, Kevin S Ikuta, Maryam Mirzaei, Andreea Mirica, Sofia Boston Redford, Siamak Sabour, Mariya Vladimirovna Titova, Davood Anvari, Ghobad Moradi, Jordi Alonso, Shiwei Liu, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Owen R. Cooper, Seyed Sina Naghibi Irvani, Kejia Hu, Hannah J. Henrikson, Sanni Yaya, Robert P. Dellavalle, Chidozie Declan Iwu, Sergey Soshnikov, Jee-Young Jasmine Choi, Satinath Mukhopadhyay, Zabihollah Yousefi, Iman El Sayed, Biresaw Wassihun Alemu, Neeti Kapoor, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nuno Taveira, Masoud Foroutan, Fatemeh Amiri, Mariam Molokhia, Songhomitra Panda-Jonas, Amy E. Peden, Rufus Akinyemi, Ejaz Ahmad Khan, Mostafa Amini-Rarani, J. Becker, Hamidreza Pazoki Toroudi, Ben Lacey, Kidanemaryam Berhe, Simon Yadgir, Spencer L. James, Cory N. Spencer, Aletta E. Schutte, Mu'awiyyah Babale Sufiyan, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Rixing Xu, Jonathan F. Mosser, Josep Maria Haro, Enrico Rubagotti, Anurag Agrawal, Zahiruddin Quazi Syed, Hoa Thi Do, Ettore Beghi, Seyed Mohammad Kazem Aghamir, Abraham Geremew, Alireza Esteghamati, Paramjit Gill, Farzad Jalilian, J. Jason West, Mikhail Sergeevich Zastrozhin, Albertino Damasceno, Bruce Bartholow Duncan, Nazir Fattahi, Daniel Cury Ribeiro, Michael Brauer, Mark A. Stokes, Veincent Christian Filipino Pepito, Lidia Morawska, Fiona J Charlson, Babak Moazen, Dejana Braithwaite, Jonathan M. Kocarnik, Sergio I. Prada, Andrea Farioli, Zahra Atafar, Heather Orpana, Daniela Balzi, Marco Vacante, Rahmatollah Moradzadeh, Jacek A. Kopec, Iván Landires, Robert G. Weintraub, Leonardo Roever, Yannick Béjot, Markus P. Schlaich, Hamed Zandian, Subramanian Senthilkumaran, Klara Dokova, Vahid Alipour, Sowmya J. Rao, Rakesh Ghosh, Omar Mukhtar Salman, Faris Lami, Marcos Roberto Tovani-Palone, Hamid Reza Tohidinik, Seyed Mohammad Riahi, Adnan Kisa, Ghasem Azarian, Caroline Stein, Zulfiqar A. Bhutta, Sinead Langan, Kunihiro Matsushita, Lauren E. Schaeffer, Kathryn H. Jacobsen, Mehdi Naderi, Mehdi Hosseinzadeh, Nizal Sarrafzadegan, Bahram Armoon, Dan J. Stein, Jessica Fanzo, Morenike Oluwatoyin Folayan, Luca Ronfani, Phetole Walter Mahasha, Nicholas J K Breitborde, Adrian Oţoiu, Arash Sarveazad, Marc L. Serre, Mostafa Hosseini, Nicolas Cherbuin, George D. Thurston, Jalal Arabloo, Mokhtar Mahdavi, Andre Rodrigues Duraes, Ana Laura Manda, Ahmed Abualhasan, Nima Rezaei, Yuan-Pang Wang, Theodore Patrick Younker, Alireza Ansari-Moghaddam, Borhan Mansouri, Adam E. Berman, Khezar Hayat, Rosario Cárdenas, Bolajoko O. Olusanya, Tommi Vasankari, Simon I. Hay, Fatemeh Ghaffarifar, Leo Stockfelt, Ai Koyanagi, Giorgia Giussani, Yuming Guo, Sonia Saxena, Deborah Carvalho Malta, Mehedi Hasan, Negar Rezaei, Maja Pasovic, Jukka Takala, Bogdan Oancea, Sare Safi, A. Werdecker, Florian Fischer, Beatriz Paulina Ayala Quintanilla, Muhammad Shahdaat Bin Sayeed, Takeshi Fukumoto, Maha Atout, Brijesh Sathian, Cristina Bosetti, Mitchell T. Wallin, Agegnehu Bante, Helen Ippolito, Anthony Masaka, Chantal Huynh, Justin Lo, Jordan Weiss, Joemer C. Maravilla, Alberto Raggi, Peter W. Gething, Cristiana Abbafati, Daniela Ribeiro, Mohammad Farahmand, Yetunde O. John-Akinola, Isabela M. Benseñor, Emilie R Maddison, John J. McGrath, Salman Khazaei, Scott B. 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Cross, Vera Marisa Costa, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Odgerel Chimed-Ochir, Sonia Rodríguez-Ramírez, Bo Norrving, Kerem Shuval, Jacob L. Stubbs, Muhammad Ali, Shuhei Nomura, Man Mohan Mehndiratta, Chisom Joyqueenet Akunna, Abdollah Mohammadian-Hafshejani, Navid Rabiee, Dana Bryazka, Hussen Mohammed, Asadollah Gholamian, Ashley Marks, Rizwan Kalani, Molly E. Herbert, Islam Y. Elgendy, Moritz U. G. Kraemer, Chuanhua Yu, Suzanne Polinder, Pascual R. Valdez, Jennifer Rickard, Kylie Ball, Turki Alanzi, Mohsen Bayati, Hamed Mirzaei, Christopher M Odell, Amira Shaheen, Ziad A. Memish, Thirunavukkarasu Sathish, Michael A. Piradov, Hamed Kalani, Lorenzo Monasta, Christopher S Yilgwan, Desalegn Getnet Demsie, Riaz Uddin, Rizwan Suliankatchi Abdulkader, Vinay Srinivasan, Hamid Ahmadieh, Claudio Alberto Dávila-Cervantes, Raffaele Palladino, Chukwudi A Nnaji, Mika Shigematsu, Stein Emil Vollset, Abbas Sheikhtaheri, Paulo A. Lotufo, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Tomislav Mestrovic, Samer Hamidi, Rajesh Sagar, Mayowa O. Owolabi, Kara Estep, Ester Cerin, Michael T. Chung, Simon Øverland, Amir Taherkhani, Sheng Chia Chung, Martin Amogre Ayanore, Nikolaos Dervenis, Joan B. Soriano, Tahereh Javaheri, Victor Adekanmbi, Seid Tiku Mereta, Gbenga A. Kayode, Christopher R. Cederroth, Razique Anwer, Rajan Nikbakhsh, Kaja Abbas, Fatemeh Heydarpour, Louisa Degenhardt, Tahiya Alam, Mohammad Miri, Alibek Mereke, David Laith Rawaf, Ippazio Cosimo Antonazzo, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Desta Debalkie Atnafu, Davide Sattin, Moslem Soofi, Edris Hasanpoor, Krittika Bhattacharyya, Mika Kivimäki, Nikolay Ivanovich Briko, Joanna L Whisnant, Christopher J L Murray, Simin Mouodi, Alize J. Ferrari, Damian Santomauro, Katrin Burkart, Tudorel Andrei, Alberto Baldasseroni, Hafiz Ansar Rasul Suleria, Valery L. Feigin, Nauman Khalid, Ewerton Cousin, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Themba G.G. Ginindza, Sadaf G. Sepanlou, Sheikh Mohammed Shariful Islam, Sanjay Basu, Getinet Ayano, Paula Moraga, Soheil Hassanipour, Jason A. Anderson, Catherine Bisignano, Iyad Sultan, Deepak Kumar Pasupula, Keivan Ahmadi, Fariba Dorostkar, Rajeev Gupta, David M. Pereira, Mustafa Z. Younis, Adel Spotin, Rasmus Havmoeller, Yeshambel T. Nigatu, Barthelemy Kuate Defo, Mithila Faruque, Alan D. Lopez, Shailesh Advani, Behshad Naghshtabrizi, Shane D. Morrison, Inga Dora Sigfusdottir, Konrad Pesudovs, Anna Gershberg Hayoon, Raaj Kishore Biswas, Reshmi Bhageerathy, H. Dean Hosgood, Giulia Carreras, Sarika Chaturvedi, James L. Fisher, In-Hwan Oh, G Anil Kumar, Christoph Nowak, Vijay Kumar Chattu, Puja C Rao, Marcel Ausloos, Ali Kabir, Rannveig Sigurvinsdottir, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Rafael Tabarés-Seisdedos, Minh Nguyen, Ashkan Afshin, Payman Salamati, Colin Angus, Mona M. 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Mini, Christian Razo, Manuela L. Ferreira, Diego De Leo, Francesco Saverio Violante, Aristidis Tsatsakis, Zahra Sadat Dibaji Forooshani, Tea Lallukka, Dickson A. Amugsi, Anna Poznańska, Graeme J. Hankey, Kewal Krishan, Maryam Zamanian, Eirini Skiadaresi, Jai K Das, Felix Greaves, Tessa M. Pilz, Sameer Vali Gopalani, Mansour Ghafourifard, M. DeLang, Morteza Mahmoudi, Alton Lu, Brian J. Hall, Ravi Prakash Jha, David Edvardsson, Xiu Ju George Zhao, Farshad Farzadfar, Hadi Hassankhani, Samuel M. Ostroff, Gerhard Sulo, Keyghobad Ghadiri, Neeraj Bhala, Stefan Lorkowski, Mohammad Rabiee, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Rashid Abdi Guled, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Afsaneh Arzani, Ayesha Humayun, Simin Liu, Maryam Khayamzadeh, Davoud Adham, Ahad Bakhtiari, Shafiu Mohammed, Paolo Lauriola, Abbas Mosapour, Sophia Emmons-Bell, Khurshid Alam, Rajat Das Gupta, Matilde Leonardi, Muktar Beshir Ahmed, Jeffrey V. Lazarus, Mohamed M. Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. 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Saeedi Moghaddam, S, Safari, Y, Safi, S, Safiri, S, Sagar, R, Sahebkar, A, Sajadi, S, Salam, N, Salamati, P, Salem, H, Salem, M, Salimzadeh, H, Salman, O, Salomon, J, Samad, Z, Samadi Kafil, H, Sambala, E, Samy, A, Sanabria, J, Sanchez-Pimienta, T, Santomauro, D, Santos, I, Santos, J, Santric-Milicevic, M, Saraswathy, S, Sarmiento-Suarez, R, Sarrafzadegan, N, Sarveazad, A, Sathian, B, Sathish, T, Sattin, D, Saxena, S, Schaeffer, L, Schiavolin, S, Schlaich, M, Schmidt, M, Schutte, A, Schwebel, D, Schwendicke, F, Senbeta, A, Senthilkumaran, S, Sepanlou, S, Serdar, B, Serre, M, Shadid, J, Shafaat, O, Shahabi, S, Shaheen, A, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamsizadeh, M, Sharafi, K, Sheikh, A, Sheikhtaheri, A, Shibuya, K, Shield, K, Shigematsu, M, Shin, J, Shin, M, Shiri, R, Shirkoohi, R, Shuval, K, Siabani, S, Sierpinski, R, Sigfusdottir, I, Sigurvinsdottir, R, Silva, J, Simpson, K, Singh, J, Singh, P, Skiadaresi, E, Skou, S, Skryabin, V, Smith, E, Soheili, A, Soltani, S, Soofi, M, Sorensen, R, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spencer, C, Spotin, A, Sreeramareddy, C, Srinivasan, V, Stanaway, J, Stein, C, Stein, D, Steiner, C, Stockfelt, L, Stokes, M, Straif, K, Stubbs, J, Sufiyan, M, Suleria, H, Suliankatchi Abdulkader, R, Sulo, G, Sultan, I, Tabares-Seisdedos, R, Tabb, K, Tabuchi, T, Taherkhani, A, Tajdini, M, Takahashi, K, Takala, J, Tamiru, A, Taveira, N, Tehrani-Banihashemi, A, Temsah, M, Tesema, G, Tessema, Z, Thurston, G, Titova, M, Tohidinik, H, Tonelli, M, Topor-Madry, R, Topouzis, F, Torre, A, Touvier, M, Tovani-Palone, M, Tran, B, Travillian, R, Tsatsakis, A, Tudor Car, L, Tyrovolas, S, Uddin, R, Umeokonkwo, C, Unnikrishnan, B, Upadhyay, E, Vacante, M, Valdez, P, van Donkelaar, A, Vasankari, T, Vasseghian, Y, Veisani, Y, Venketasubramanian, N, Violante, F, Vlassov, V, Vollset, S, Vos, T, Vukovic, R, Waheed, Y, Wallin, M, Wang, Y, Watson, A, Wei, J, Wei, M, Weintraub, R, Weiss, J, Werdecker, A, West, J, Westerman, R, Whisnant, J, Whiteford, H, Wiens, K, Wolfe, C, Wozniak, S, Wu, A, Wu, J, Wulf Hanson, S, Xu, G, Xu, R, Yadgir, S, Yahyazadeh Jabbari, S, Yamagishi, K, Yaminfirooz, M, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeheyis, T, Yilgwan, C, Yilma, M, Yip, P, Yonemoto, N, Younis, M, Younker, T, Yousefi, B, Yousefi, Z, Yousefinezhadi, T, Yousuf, A, Yu, C, Yusefzadeh, H, Moghadam, T, Zamani, M, Zamanian, M, Zandian, H, Zastrozhin, M, Zhang, Y, Zhang, Z, Zhao, J, Zhao, X, Zhao, Y, Zheng, P, Zhou, M, Ziapour, A, Zimsen, S, Lim, S, Murray, C, GBD 2019 Risk Factors Collaborator, Violante FS, Biosciences, Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Sub Foundations&PhilosophyofNaturSc begr, IRAS OH Epidemiology Chemical Agents, dIRAS RA-2, Public Health, Bin Sayeed, M. S. B., Caetano Dos Santos, F. L., Camera, L. A., Elyazar, I. R. F., Ayalew Gebreslassie, A. A. A., Ginindza, T. G., Matin, B. K., Morgado-Da-Costa, J., Khaneghah, A. M., Mahesh, P. A., Toroudi, H. P., Syed, Z. Q., Salem, M. R., Skou, S. T., Tovani-Palone, M. R., Tudor Car, L. T., and Moghadam, T. Z.
Subjects: Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract: Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
Published: 2020

39. Fine particulate matter constituents and cause-specific mortality in China: A nationwide modelling study

Author: Jun Yang, Mengmeng Li, Boguang Wang, Chunlin Zhang, Hao Wang, Peng Yin, Qiyong Liu, Jianlin Hu, and Maigeng Zhou
Subjects: Distributed lag, China, 010504 meteorology & atmospheric sciences, Low resource, Restricted maximum likelihood, Fine particulate, 010501 environmental sciences, 01 natural sciences, PM2.5 constituents, Interquartile range, Environmental health, Air Pollution, Cause of Death, Cause-specific mortality, Medicine, Humans, Mortality, Air quality index, Disease burden, lcsh:Environmental sciences, 0105 earth and related environmental sciences, General Environmental Science, Aged, lcsh:GE1-350, Air Pollutants, business.industry, Cause specific mortality, Vulnerable population, Particulate Matter, business
Abstract: Background Fine particulate matter (with aerodynamic diameter ≤2.5 µm, PM2.5) causes huge disease burden worldwide. However, evidence is still inadequate and inconsistent on the relationships between PM2.5 constituents and mortality, especially in low resource settings. Objectives To evaluate the impact of PM2.5 constituents on cause-specific mortality in China. Methods We obtained daily mortality data for 161 communities in 2011–2013 from the Disease Surveillance Point system in China. Daily concentrations of major PM2.5 constituents, including organic carbon (OC), elemental carbon (EC), sulphate ( SO 4 2- ), nitrate ( NO 3 - ) and ammonium ( NH 4 + ), were estimated by using the modified Community Multiscale Air Quality model. For each community, we applied quasi-Poisson regression and polynomial distributed lag models to estimate the effects of PM2.5 constituents on cause-specific mortality. Then, the pooled effect estimates were calculated by a random-effect meta-analysis based on the restricted maximum likelihood estimation. Stratification analyses were performed by region, gender, age group and education level to identify the vulnerable populations. Results Each interquartile range change of EC, OC, SO 4 2- , NO 3 - and NH 4 + at lag 0–3 day was associated with increments in non-accidental mortality of 0.45% (95%CI: 0.21, 0.69), 1.43% (0.97, 1.89), 0.71% (0.28, 1.15), 0.70% (0.10, 1.30) and 0.95% (0.39, 1.51), respectively. The associations were stronger for the deaths from cardiovascular disease and myocardial infarction, the elderly, illiterates, and people living in the South region. Conclusions Our findings suggest positive associations between PM2.5 constituents and cause-specific mortality, particularly for myocardial infarction.
Published: 2020

40. Long-term exposure to ambient temperature and mortality risk in China: A nationwide study using the difference-in-differences design

Author: Xiaojun Xu, Chunliang Zhou, Zhulin Hou, Jianxiong Hu, Junhua Li, Donghui Jin, Xing Li, Qinglong Zhao, Cunrui Huang, Yanjun Xu, Min Yu, Biao Huang, Wenjun Ma, Mingfang Qin, Tao Liu, Lifeng Lin, Ruying Hu, Yiqing Xu, Guanhao He, Weilin Zeng, Peng Yin, Weiwei Gong, Maigeng Zhou, Jianpeng Xiao, Yize Xiao, and Shilu Tong
Subjects: China, medicine.medical_specialty, Low education, Health, Toxicology and Mutagenesis, Population, Younger people, Toxicology, Air Pollution, Epidemiology, Humans, Medicine, Mortality, education, Socioeconomic status, Aged, Air Pollutants, education.field_of_study, business.industry, Temperature, Environmental Exposure, General Medicine, Pollution, Difference in differences, Total mortality, Seasons, business, Effect modification, Demography
Abstract: The short-term effects of ambient temperature on mortality have been widely investigated. However, the epidemiological evidence on the long-term effects of temperature on mortality is rare. In present study, we conducted a nationwide quasi-experimental design, which based on a variant of difference-in-differences (DID) approach, to examine the association between long-term exposure to ambient temperature and mortality risk in China, and to analyze the effect modification of population characteristics and socioeconomic status. Data on mortality were collected from 364 communities across China during 2006–2017, and environmental data were obtained for the same period. We estimated a 2.93 % (95 % CI: 2.68 %, 3.18 %) increase in mortality risk per 1 °C decreases in annual temperature, the greater effects were observed on respiratory diseases (5.16 %, 95 % CI: 4.53 %, 5.79 %) than cardiovascular diseases (3.43 %, 95 % CI: 3.06 %, 3.80 %), and on younger people (4.21 %, 95 % CI: 3.73 %, 4.68 %) than the elderly (2.36 %, 95 % CI: 2.06 %, 2.65 %). In seasonal analysis, per 1 °C decreases in average temperature was associated with 1.55 % (95 % CI: 1.23 %, 1.87 %), −0.53 % (95 % CI: −0.89 %, −0.16 %), 2.88 % (95 % CI: 2.45 %, 3.31 %) and 4.21 % (95 % CI: 3.98 %, 4.43 %) mortality change in spring, summer, autumn and winter, respectively. The effects of long-term temperature on total mortality were more pronounced among the communities with low urbanization, low education attainment, and low GDP per capita. In total, the decrease of average temperature in summer decreased mortality risk, while increased mortality risk in other seasons, and the associations were modified by demographic characteristics and socioeconomic status. Our findings suggest that populations with disadvantaged characteristics and socioeconomic status are vulnerable to long-term exposure of temperature, and targeted policies should be formulated to strengthen the response to the health threats of temperature exposure.
Published: 2022

41. Age-specific disparity in life loss per death attributable to ambient temperature: A nationwide time-series study in China

Author: Min Yu, Wenjun Ma, Shannon Rutherford, Ruying Hu, Biao Huang, Xing Li, Weiwei Gong, Siqi Chen, Guanhao He, Mingfang Qin, Lifeng Lin, Donghui Jin, Maigeng Zhou, Yize Xiao, Jianpeng Xiao, Xiaojun Xu, Chunliang Zhou, Cunrui Huang, Yiqing Xu, Junhua Li, Jianxiong Hu, Zhulin Hou, Weilin Zeng, Weizhen Mai, Xianbo Wu, Peng Yin, Yonghui Zhang, Yanjun Xu, and Tao Liu
Subjects: Adult, China, Hot Temperature, Adolescent, Temperature a, Biochemistry, Young Adult, Age groups, Humans, Mortality, Time series study, Child, health care economics and organizations, Aged, General Environmental Science, Cause of death, Age Factors, Infant, Newborn, Temperature, Infant, Middle Aged, Age specific, Moderate temperature, Cold Temperature, Years of potential life lost, Child, Preschool, Population data, Demography
Abstract: Age-specific discrepancy of mortality burden attributed to temperature, measured as years of life lost (YLL), has been rarely investigated. We investigated age-specific temperature-YLL rates (per 100,000) relationships and quantified YLL per death caused by non-optimal temperature in China. We collected daily meteorological data, population data and daily death counts from 364 locations in China during 2006–2017. YLL was divided into three age groups (0–64 years, 65–74 years, and ≥75 years). A distributed lag non-linear model was first employed to estimate the associations of temperature with age-specific YLL rates in each location. Then we pooled the associations using a multivariate meta-analysis. Finally, we calculated age-specific average YLL per death caused by temperature by cause of death and region. We observed greater effects of cold and hot temperature on YLL rates for the elderly compared with the young population by region or cause of death. However, YLL per death due to non-optimal temperature for different regions or causes of death decreased with age, with 2.0 (95 % CI:1.5, 2.5), 1.2 (1.1, 1.4) and 1.0 years (0.9, 1.2) life loss per death for populations aged 0–64 years, 65–74 years and over 75 years, respectively. Most life loss per death results from moderate temperature, especially moderate cold for all age groups. The effect of non-optimal temperature on YLL rates is smaller for younger populations than older ones, while the temperature-related life loss per death was more prominent for younger populations.
Published: 2022

42. Ambient ozone pollution and years of life lost: Association, effect modification, and additional life gain from a nationwide analysis in China

Author: Maigeng Zhou, Lijun Wang, Peng Yin, Jie Li, Jiangmei Liu, Xiao Zhang, and Yunning Liu
Subjects: Pollution, China, Ozone, Time series, 010504 meteorology & atmospheric sciences, media_common.quotation_subject, 010501 environmental sciences, 01 natural sciences, Ambient ozone, chemistry.chemical_compound, Environmental health, Air Pollution, Medicine, Humans, Cities, Mortality, Modifier, Disease burden, health care economics and organizations, lcsh:Environmental sciences, 0105 earth and related environmental sciences, General Environmental Science, Cardiopulmonary disease, media_common, lcsh:GE1-350, Air Pollutants, business.industry, Additional life gain, Environmental Exposure, Confidence interval, Years of potential life lost, chemistry, Particulate Matter, business, Effect modification, Years of life lost
Abstract: Background Ozone is one of the dominant air pollutants due to its impact on disease burden and increasing trend in concentration. However, evidence regarding short-term effect of ozone on years of life lost (YLL) is scarce. Methods A national time-series study was conducted in 48 large Chinese cities from 2013 to 2017. Generalized additive model coupled with random effects model were used to estimate national-average associations of ozone with YLL. Potential modifiers and additional life gain due to avoidable YLL under certain scenario were also evaluated. Results The average annual mean ozone concentration of these cities was 86.9 μg/m3. For 10 μg/m3 increase in 3-day moving average ozone concentration, we estimated 0.37% [95% confidence interval (CI): 0.29%, 0.46%] increase in YLL from nonaccidental causes, 0.38% (95% CI: 0.30%, 0.46%) increase in YLL from cardiovascular diseases, and 0.36% (95% CI: 0.16%, 0.56%) increase in YLL from respiratory diseases. Moreover, the associations were more evident in people with less education and in cities with lower carbon monoxide concentration or those located at north region with lower mean temperature. Finally, an estimated life of 0.055 (95% CI: 0.043, 0.068) years would be gained per deceased people if ozone concentration could fall to 100 μg/m3. Conclusions Our findings indicated robust associations between short-term exposure to ozone and YLL from nonaccidental causes and cardiopulmonary diseases. Relevant intervention design should take the heterogeneity of both individual- and city-level characteristics into account. Implementation of more stringent standard is beneficial for alleviating YLL caused by ozone.
Published: 2020

43. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Sorin Hostiuc, Shaun Wen Huey Lee, Jorge R. Ledesma, Carsten Flohr, Masoumeh Sadeghi, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Mehdi Bohluli, Félix Carvalho, Yun Jin Kim, Catalina Liliana Andrei, Seyyed Meysam Mousavi, Bernhard T. Baune, Ehsan Ahmadpour, Dinh-Toi Chu, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Mohammad Taghi Khodayari, Gianna Gayle Herrera Amul, Arash Tehrani-Banihashemi, Govinda Prasad Dhungana, Fereshteh Ansari, Michael K. Hole, Azeem Majeed, Iman Halvaei, Saqib Ali, Arianna Maever L. Amit, Tomas Y. Yeheyis, John S. Ji, Martin McKee, Jamileh Shadid, Leonardo Roever, Peng Jia, Ettore Beghi, Pablo M. Lavados, Young Eun Kim, Vahid Alipour, Sowmya J. Rao, Ahmad Daryani, Cathleen Keller, Ibrahim Abdollahpour, Nicole K. DeCleene, Ebrahim Babaee, Saman Esmaeilnejad, Boris Bikbov, William M. Gardner, Lydia M. Haile, Luca Ronfani, Azalea M. Thomson, Irena Ilic, Ruth W. Kimokoti, Yingxi Zhao, Guoqing Hu, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Nathaniel J. Henry, Brijesh Sathian, Daniel Kim, Peter Memiah, Mohammad Hadi Abbasi, Andrea Farioli, Zahra Kamiab, Bolajoko O. Olusanya, Matthew C. Doxey, Tommi Vasankari, Hamideh Salimzadeh, Luisa Sorio Flor, Priya Rathi, Shanshan Li, Tanvir M. Huda, Dillon O Sylte, Rosario Cárdenas, Agegnehu Bante, Helen Ippolito, Alyssa Acebedo, Jeffrey D. Stanaway, Anwar Faraj, João Pedro Silva, Amin Mousavi Khaneghah, Pushpendra Kumar, Sangram Kishor Patel, Josephine W. Ngunjiri, Holly E. Erskine, Eugene Sobngwi, Filippo Ariani, Shane D. Morrison, Mohammad Aghaali, Meghan D. Mooney, Vera Marisa Costa, Palash Chandra Banik, Rupak Desai, Ken Takahashi, Maigeng Zhou, Morteza Oladnabi, Bogdan Oancea, Daniela Ribeiro, Mohammad Farahmand, Irmina Maria Michalek, Yetunde O. John-Akinola, Khem Narayan Pokhrel, Emilie R Maddison, Syed Mohamed Aljunid, Damian G. Hoy, Hosni Salem, V. Prakash, Shuhei Nomura, Inga Dora Sigfusdottir, Anders Larsson, Sharareh Eskandarieh, Abdollah Mohammadian-Hafshejani, Somayeh Bohlouli, Joana Morgado-da-Costa, Siamak Sabour, Theo Vos, Han Yong Wunrow, Khaled Khatab, Alireza Zangeneh, Ann Kristin Knudsen, Marissa B Reitsma, Hannah J. Henrikson, Randah R. Hamadeh, Tuomo J. Meretoja, Ireneous N. Soyiri, Giuseppe Grosso, Ziyad Al-Aly, Taraneh Yousefinezhadi, Joseph L Ward, Roba Khundkar, Ricardo Santiago Gomez, Reza Malekzadeh, John J. McGrath, Sandra B. Munro, Shahin Soltani, Amy E. Peden, Rufus Akinyemi, Marcel Ausloos, Naohiro Yonemoto, Bogdan Wojtyniak, Ahmad Ghashghaee, Guilherme Borges, Sadia Bibi, Farhad Islami, Hamed Mirzaei, Mohammad Ali Sahraian, M. Ashworth Dirac, Hosna Janjani, Kairat Davletov, Hermann Brenner, Yuichiro Yano, Elissa M. Abrams, Ana Vukovic, Bartosz Miazgowski, Jobert Richie Nansseu, Jennifer O Lam, Mona Pathak, Leeberk Raja Inbaraj, Thirunavukkarasu Sathish, Asadollah Gholamian, Carlos A Castañeda-Orjuela, Babak Eshrati, Edgar Denova-Gutiérrez, Atte Meretoja, Lorenzo Monasta, Ronan A. Lyons, Neda Kianipour, Desalegn Getnet Demsie, Yasir Waheed, Desta Debalkie Atnafu, Davide Sattin, Kevin S Ikuta, Ghobad Moradi, Srinivas Goli, Krittika Bhattacharyya, Mika Kivimäki, Christopher Troeger, Jordi Alonso, Alireza Ahmadi, Navid Manafi, Caroline Stein, Songhomitra Panda-Jonas, Jason Nguyen, Moses K. Muriithi, Aziz Rezapour, Ismael R. Campos-Nonato, Adrian Pana, H. Dean Hosgood, Noore Alam, James L. Fisher, Mariam Molokhia, Susan F. Rumisha, Ernoiz Antriyandarti, Ayman Grada, Emma Nichols, Babak Asghari, André Luiz Sena Guimarães, Ferrán Catalá-López, Aletta E. Schutte, Fiona B. Bennitt, Maciej Banach, Antonio Biondi, Donal Bisanzio, Josip Car, Ronny Westerman, Shafiu Mohammed, Biniyam Sahiledengle Geberemariyam, Kenji Shibuya, Meghdad Pirsaheb, Milena Santric-Milicevic, Karen M. Tabb, Paula Moraga, Soheil Hassanipour, Hasan Yusefzadeh, Avina Vongpradith, Dara K. Mohammad, Ralph Maddison, Babak Moazen, Getachew Mullu Kassa, Rahman Shiri, Fernando Neves Hugo, Hmwe H Kyu, Zachary V Dingels, Florian Fischer, Valentin Yurievich Skryabin, Rafael Tabarés-Seisdedos, Massimo Cirillo, Nikita Otstavnov, Robert C. Reiner, Van C. Lansingh, Rodrigo Sarmiento-Suarez, Ashkan Afshin, Benjamin A Stark, Mohsen Abbasi-Kangevari, Natalie C. Galles, Behnam Heidari, Eun-Kee Park, Mohammad Ali Jahani, Suzanne Polinder, Mahalaqua Nazli Khatib, Farhad Jadidi-Niaragh, Amir Radfar, Mowafa Househ, Derrick A Bennett, Gaorui Guo, Hesam Ghiasvand, Taweewat Wiangkham, Tamás Joó, Cristiana Abbafati, Kathryn Mei Ming Lau, Anita K. Nandi, Miklós Szócska, Manasi Kumar, Eduardo A. Undurraga, Oladimeji M. Adebayo, Simon Yadgir, Victor Aboyans, Justin J. Lang, Catherine O. Johnson, Soewarta Kosen, Carla Sofia e.Sá Farinha, Marcos Roberto Tovani-Palone, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Heather Orpana, Samuel B. Albertson, Mahdi Afshari, Nicholas J K Breitborde, Nelson J. Alvis-Zakzuk, Adrian Oţoiu, Iván Landires, Robert G. Weintraub, Kidanemaryam Berhe, André Faro, Sophia Emmons-Bell, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Yordanos Gizachew Yeshitila, Mehdi Hosseinzadeh, Arash Etemadi, Oleguer Plana-Ripoll, Theodore Patrick Younker, Joemer C. Maravilla, Alireza Ansari-Moghaddam, Borhan Mansouri, Narayanaswamy Venketasubramanian, Seyed Mohammad Kazem Aghamir, Linda Morales, Amanda Deen, Noushin Mohammadifard, Obinna Onwujekwe, Ai Koyanagi, Michele Nguyen, Chieh Han, Kiana Ramezanzadeh, Mika Shigematsu, Mohammed Shannawaz, Khurshid Alam, Javad Nazari, Bryan L. 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L., Department of Public Health, Clinicum, Department of Neurosciences, HUS Comprehensive Cancer Center, Environmental Sciences, Public Health, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, GBD 2019 Diseases and Injuries Collaborator, Violante FS, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, and UT-I-ITC-ACQUAL
Subjects: Male, Life expectancy, Disability-Adjusted Life Year, Diseases, Disease, communicable disease, systematic analysis, Global Burden of Disease, 0302 clinical medicine, 80 and over, Medicine, 10. No inequality, Child, 11 Medical and Health Sciences, injuries, Aged, 80 and over, education.field_of_study, Sjúkdómar, DEMENTIA, FALLS, General Medicine, Forvarnir, 3. Good health, Child, Preschool, Human, GBD, Population health, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Humans, Global Burden of Disease Study, education, Aged, Spatial Analysis, Global burden, Disability, Prevention, DISABILITY, Infant, Spatial Analysi, Mortality rate, Global Burden of Disease, Diseases, Injuries, Systematic analysis, PREVENTION, Years of potential life lost, Risk factors, Disease study, ITC-ISI-JOURNAL-ARTICLE, RISK-FACTORS, Clinical Medicine, RA, Demography, Fötlun, Dánartíðni, Áhættuþættir, 030204 cardiovascular system & hematology, Risk Factors, Cause of Death, Global health, 030212 general & internal medicine, 1. No poverty, Disability-Adjusted Life Years, Public Health, Global Health, Social Medicine and Epidemiology, Middle Aged, 3142 Public health care science, environmental and occupational health, Adolescent, Adult, Age Distribution, Female, Infant, Newborn, Young Adult, Lýðheilsa, CLINICAL-TRIALS, Population, Settore MED/01 - Statistica Medica, diseases, ITC-HYBRID, Heilbrigðisvísindi, General & Internal Medicine, Mortality, Preschool, Disease burden, business.industry, Risk Factor, Klinisk medicin, Newborn, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Áverkar, Systematic analysis, NA, business
Abstract: Publisher's version (útgefin grein), Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd., Research reported in this publication was supported by the Bill & Melinda Gates Foundation; the University of Melbourne; Queensland Department of Health, Australia; the National Health and Medical Research Council, Australia; Public Health England; the Norwegian Institute of Public Health; St Jude Children's Research Hospital; the Cardiovascular Medical Research and Education Fund; the National Institute on Ageing of the National Institutes of Health (award P30AG047845); and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated, the National Health Service (NHS), the National Institute for Health Research (NIHR), the UK Department of Health and Social Care, or Public Health England; the United States Agency for International Development (USAID), the US Government, or MEASURE Evaluation; or the European Centre for Disease Prevention and Control (ECDC). This research used data from the Chile National Health Survey 2003, 2009-10, and 2016-17. The authors are grateful to the Ministry of Health, the survey copyright owner, for allowing them to have the database. All results of the study are those of the authors and in no way committed to the Ministry. The Costa Rican Longevity and Healthy Aging Study project is a longitudinal study by the University of Costa Rica's Centro Centroamericano de Poblacion and Instituto de Investigaciones en Salud, in collaboration with the University of California at Berkeley. The original pre-1945 cohort was funded by the Wellcome Trust (grant 072406), and the 1945-55 Retirement Cohort was funded by the US National Institute on Aging (grant R01AG031716). The principal investigators are Luis Rosero-Bixby and William H Dow and co-principal investigators are Xinia Fernandez and Gilbert Brenes. The accuracy of the authors' statistical analysis and the findings they report are not the responsibility of ECDC. ECDC is not responsible for conclusions or opinions drawn from the data provided. ECDC is not responsible for the correctness of the data and for data management, data merging and data collation after provision of the data. ECDC shall not be held liable for improper or incorrect use of the data. The Health Behaviour in School-Aged Children (HBSC) study is an international study carried out in collaboration with WHO/EURO. The international coordinator of the 1997-98, 2001-02, 2005-06, and 2009-10 surveys was Candace Currie and the databank manager for the 1997-98 survey was Bente Wold, whereas for the following surveys Oddrun Samdal was the databank manager. A list of principal investigators in each country can be found on the HBSC website. Data used in this paper come from the 2009-10 Ghana Socioeconomic Panel Study Survey, which is a nationally representative survey of more than 5000 households in Ghana. The survey is a joint effort undertaken by the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana and the Economic Growth Centre (EGC) at Yale University. It was funded by EGC. ISSER and the EGC are not responsible for the estimations reported by the analysts. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law, 2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Data for this research was provided by MEASURE Evaluation, funded by USAID. The authors thank the Russia Longitudinal Monitoring Survey, conducted by the National Research University Higher School of Economics and ZAO Demoscope together with Carolina Population Center, University of North Carolina at Chapel Hill and the Institute of Sociology, Russia Academy of Sciences for making data available. This paper uses data from the Bhutan 2014 STEPS survey, implemented by the Ministry of Health with the support of WHO; the Kuwait 2006 and 2014 STEPS surveys, implemented by the Ministry of Health with the support of WHO; the Libya 2009 STEPS survey, implemented by the Secretariat of Health and Environment with the support of WHO; the Malawi 2009 STEPS survey, implemented by Ministry of Health with the support of WHO; and the Moldova 2013 STEPS survey, implemented by the Ministry of Health, the National Bureau of Statistics, and the National Center of Public Health with the support of WHO. This paper uses data from Survey of Health, Ageing and Retirement in Europe (SHARE) Waves 1 (DOI:10.6103/SHARE. w1.700), 2 (10.6103/SHARE.w2.700), 3 (10.6103/SHARE.w3.700), 4 (10.6103/SHARE.w4.700), 5 (10.6103/SHARE.w5.700), 6 (10.6103/SHARE.w6.700), and 7 (10.6103/SHARE.w7.700); see Borsch-Supan and colleagues (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N degrees 211909, SHARE-LEAP: GA N degrees 227822, SHARE M4: GA N degrees 261982) and Horizon 2020 (SHARE-DEV3: GA N degrees 676536, SERISS: GA N degrees 654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged. This study has been realised using the data collected by the Swiss Household Panel, which is based at the Swiss Centre of Expertise in the Social Sciences. The project is financed by the Swiss National Science Foundation. The United States Aging, Demographics, and Memory Study is a supplement to the Health and Retirement Study (HRS), which is sponsored by the National Institute of Aging (grant number NIA U01AG009740). It was conducted jointly by Duke University and the University of Michigan. The HRS is sponsored by the National Institute on Aging (grant number NIA U01AG009740) and is conducted by the University of Michigan. This paper uses data from Add Health, a program project designed by J Richard Udry, Peter S Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due to Ronald R Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website. No direct support was received from grant P01-HD31921 for this analysis. The data reported here have been supplied by the United States Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. Collection of data for the Mozambique National Survey on the Causes of Death 2007-08 was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. This manuscript is based on data collected and shared by the International Vaccine Institute (IVI) from an original study IVI conducted. L G Abreu acknowledges support from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Brazil; finance code 001) and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, a Brazilian funding agency). I N Ackerman was supported by a Victorian Health and Medical Research Fellowship awarded by the Victorian Government. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. A Agrawal acknowledges the Wellcome Trust DBT India Alliance Senior Fellowship. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. M Ausloos, C Herteliu, and A Pana acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. A Badawi is supported by the Public Health Agency of Canada. D A Bennett was supported by the NIHR Oxford Biomedical Research Centre. R Bourne acknowledges the Brien Holden Vision Institute, University of Heidelberg, Sightsavers, Fred Hollows Foundation, and Thea Foundation. G B Britton and I Moreno Velasquez were supported by the Sistema Nacional de Investigacion, SNI-SENACYT, Panama. R Buchbinder was supported by an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship. J J Carrero was supported by the Swedish Research Council (2019-01059). F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. A R Chang was supported by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grant K23 DK106515. V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundacao para a Ciencia e Tecnologia, IP, under the Norma Transitaria DL57/2016/CP1334/CT0006. A Douiri acknowledges support and funding from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust and the Royal College of Physicians, and support from the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. B B Duncan acknowledges grants from the Foundation for the Support of Research of the State of Rio Grande do Sul (IATS and PrInt) and the Brazilian Ministry of Health. H E Erskine is the recipient of an Australian NHMRC Early Career Fellowship grant (APP1137969). A J Ferrari was supported by a NHMRC Early Career Fellowship grant (APP1121516). H E Erskine and A J Ferrari are employed by and A M Mantilla-Herrera and D F Santomauro affiliated with the Queensland Centre for Mental Health Research, which receives core funding from the Queensland Department of Health. M L Ferreira holds an NHMRC Research Fellowship. C Flohr was supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust. M Freitas acknowledges financial support from the EU (European Regional Development Fund [FEDER] funds through COMPETE POCI-01-0145-FEDER-029248) and National Funds (Fundacao para a Ciencia e Tecnologia) through project PTDC/NAN-MAT/29248/2017. A L S Guimaraes acknowledges support from CNPq. C Herteliu was partially supported by a grant co-funded by FEDER through Operational Competitiveness Program (project ID P_40_382). P Hoogar acknowledges Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education and Centre for Holistic Development and Research, Kalaghatagi. F N Hugo acknowledges the Visiting Professorship, PRINT Program, CAPES Foundation, Brazil. B-F Hwang was supported by China Medical University (CMU107-Z-04), Taichung, Taiwan. S M S Islam was funded by a National Heart Foundation Senior Research Fellowship and supported by Deakin University. R Q Ivers was supported by a research fellowship from the National Health and Medical Research Council of Australia. M Jakovljevic acknowledges the Serbian part of this GBD-related contribution was co-funded through Grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. P Jeemon was supported by a Clinical and Public Health intermediate fellowship (grant number IA/CPHI/14/1/501497) from the Wellcome Trust-Department of Biotechnology, India Alliance (2015-20). O John is a recipient of UIPA scholarship from University of New South Wales, Sydney. S V Katikireddi acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13, MC_UU_12017/15), and the Scottish Government Chief Scientist Office (SPHSU13, SPHSU15). C Kieling is a CNPq researcher and a UK Academy of Medical Sciences Newton Advanced Fellow. Y J Kim was supported by Research Management Office, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/00010). K Krishan is supported by UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar was supported by K43 TW 010716 FIC/NIMH. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. J V Lazarus was supported by a Spanish Ministry of Science, Innovation and Universities Miguel Servet grant (Instituto de Salud Carlos III [ISCIII]/ESF, the EU [CP18/00074]). K J Looker thanks the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol, in partnership with Public Health England, for research support. S Lorkowski was funded by the German Federal Ministry of Education and Research (nutriCARD, grant agreement number 01EA1808A). R A Lyons is supported by Health Data Research UK (HDR-9006), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, NIHR (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. J J McGrath is supported by the Danish National Research Foundation (Niels Bohr Professorship), and the Queensland Health Department (via West Moreton HHS). P T N Memiah acknowledges support from CODESRIA. U O Mueller gratefully acknowledges funding by the German National Cohort Study BMBF grant number 01ER1801D. S Nomura acknowledges the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18K10082). A Ortiz was supported by ISCIII PI19/00815, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009 Fondos FEDER, FRIAT, Comunidad de Madrid B2017/BMD-3686 CIFRA2-CM. These funding sources had no role in the writing of the manuscript or the decision to submit it for publication. S B Patten was supported by the Cuthbertson & Fischer Chair in Pediatric Mental Health at the University of Calgary. G C Patton was supported by an aNHMRC Senior Principal Research Fellowship. M R Phillips was supported in part by the National Natural Science Foundation of China (NSFC, number 81371502 and 81761128031). A Raggi, D Sattin, and S Schiavolin were supported by grants from the Italian Ministry of Health (Ricerca Corrente, Fondazione Istituto Neurologico C Besta, Linea 4-Outcome Research: dagli Indicatori alle Raccomandazioni Cliniche). P Rathi and B Unnikrishnan acknowledge Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. A L P Ribeiro was supported by Brazilian National Research Council, CNPq, and the Minas Gerais State Research Agency, FAPEMIG. D C Ribeiro was supported by The Sir Charles Hercus Health Research Fellowship (#18/111) Health Research Council of New Zealand. D Ribeiro acknowledges financial support from the EU (FEDER funds through the Operational Competitiveness Program; POCI-01-0145-FEDER-029253). P S Sachdev acknowledges funding from the NHMRC of Australia Program Grant. A M Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. M M Santric-Milicevic acknowledges the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). R Sarmiento-Suarez received institutional support from Applied and Environmental Sciences University (Bogota, Colombia) and ISCIII (Madrid, Spain). A E Schutte received support from the South African National Research Foundation SARChI Initiative (GUN 86895) and Medical Research Council. S T S Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council under the EU's Horizon 2020 research and innovation program (grant agreement number 801790). J B Soriano is funded by Centro de Investigacion en Red de Enfermedades Respiratorias, ISCIII. R Tabares-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. N Taveira was partially supported by the European & Developing Countries Clinical Trials Partnership, the EU (LIFE project, reference RIA2016MC-1615). S Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral programme (reference number CD15/00019 from ISCIII-FEDER). S B Zaman received a scholarship from the Australian Government research training programme in support of his academic career., "Peer Reviewed"
Published: 2020

44. Age-Period-Cohort Analysis of Type 2 Diabetes Mortality Attributable to Particulate Matter Pollution in China and the U.S

Author: Zhi-Jiang Zhang, Maigeng Zhou, Xiaoxue Liu, and Chuanhua Yu
Subjects: Adult, Male, Pollution, China, Article Subject, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Type 2 diabetes, Diseases of the endocrine glands. Clinical endocrinology, Cohort Studies, Endocrinology, Pollution in China, Air Pollution, Humans, Medicine, Mortality, Aged, media_common, Aged, 80 and over, business.industry, Mortality rate, Age Factors, Middle Aged, Particulates, RC648-665, medicine.disease, United States, Diabetes Mellitus, Type 2, Cohort effect, Cohort, Female, Particulate Matter, business, Research Article, Demography, Cohort study
Abstract: Aim. We aimed to assess and compare secular trends in type 2 diabetes mortality attributable to particulate matter pollution in China and U.S. Methods. We performed an age-period-cohort (APC) analysis to estimate the independent effects of age, period, and cohort on mortality of type 2 diabetes attributable to particulate matter pollution. We collected age-standardized and age-specific mortality rates (1990-2017) from the Global Burden of Disease 2017 Study for China and the U.S. Results. During the period 1990-2017, the age-standardized mortality rates of type 2 diabetes attributable to particulate matter pollution in China showed a general increasing trend, while that in U.S. showed an increase before 2002 and subsequently a decrease. The age effect increased markedly in China compared with the U.S. The period effect showed a substantially increase in China while that in the U.S. increased during 1990-2007 and tended to be stable during 2007-2017. The cohort effect peaked in birth cohort born in 1902–1906 in both China and U.S. and declined consistently in the cohort born in 1992-1996. Conclusions. The age-standardized mortality rates of type 2 diabetes attributable to particulate matter pollution, the age, and period effect in China have been increasing in both sexes from 1990 to 2017. The overall mortality in the U.S. began to decrease since 2003, and the period effect showed a tendency to stabilize. Consequently, it is necessary to educate the nation with the correct knowledge and adopting policies on pollutant emission and techniques to reduce air pollution in China.
Published: 2020
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45. Diabetes mortality burden attributable to short-term effect of PM

Author: Jun, Yang, Maigeng, Zhou, Fengying, Zhang, Peng, Yin, Boguang, Wang, Yuming, Guo, Shilu, Tong, Hao, Wang, Chunlin, Zhang, Qinghua, Sun, Xiuping, Song, and Qiyong, Liu
Subjects: Adult, Male, Air Pollutants, China, Adolescent, Infant, Newborn, Infant, Environmental Exposure, Middle Aged, Young Adult, Air Pollution, Child, Preschool, Diabetes Mellitus, Humans, Female, Particulate Matter, Cities, Mortality, Child, Aged
Abstract: 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 PM
Published: 2019

46. Associations Between Ambient Nitrogen Dioxide and Daily Cause-specific Mortality

Author: Cong Liu, Peng Yin, Yunning Liu, Xia Meng, Renjie Chen, Jinlei Qi, Jiangmei Liu, Lijun Wang, Jinling You, Yue Niu, Maigeng Zhou, Haidong Kan, and Zhijing Lin
Subjects: Adult, Male, China, Adolescent, Epidemiology, Nitrogen Dioxide, 010501 environmental sciences, complex mixtures, 01 natural sciences, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Environmental health, Humans, Medicine, Nitrogen dioxide, 030212 general & internal medicine, Cities, Mortality, Young adult, Child, Mortality trends, Aged, 0105 earth and related environmental sciences, Air Pollutants, business.industry, Cause specific mortality, Bayes Theorem, Environmental Exposure, Middle Aged, respiratory system, chemistry, Child, Preschool, Linear Models, Female, business
Abstract: There has been a long history of debate regarding whether ambient nitrogen dioxide (NO2) directly affects human health.We conducted a nationwide time-series analysis in 272 major Chinese cities (2013-2015) to evaluate the associations between short-term exposure to NO2 and cause-specific mortality. We used the overdispersed generalized linear model together with the Bayesian hierarchical model to estimate the associations between NO2 and mortality at the national and regional levels. We examined two-pollutant models with adjustment of fine particles, sulfur dioxide, carbon monoxide, and ozone to evaluate robustness for the effects of NO2.At the national-average level, we observed linear and positive associations between NO2 and mortality from all causes and main cardiorespiratory diseases. A 10 μg/m increase in 2-day average concentrations of NO2 would lead to increments of 0.9% (95% posterial interval [PI], 0.7%, 1.1%) in mortality from total nonaccidental causes, 0.9% (95% PI, 0.7%, 1.2%) from total cardiovascular disease, 1.4% (95% PI, 0.8%, 2.0%) from hypertension, 0.9% (95% PI, 0.6%, 1.2%) from coronary heart disease, 0.9% (95% PI, 0.5%, 1.2%) from stroke, 1.2% (95% PI, 0.9%, 1.5%) from total respiratory diseases, and 1.6% (95% PI, 1.1%, 2.0%) from chronic obstructive pulmonary disease. There were no appreciable differences in estimates from single-pollutant and two-pollutant models. The associations were stronger in the south of China, in the elderly, and in females.The present study provided robust epidemiologic evidence of associations between day-to-day NO2 and mortality from total natural causes and main cardiorespiratory diseases that might be independent of other criteria air pollutants.
Published: 2018

47. Diurnal temperature range in relation to death from stroke in China

Author: Peng Yin, Thomas Krafft, Mengmeng Li, Yunning Liu, Eva Pilot, Jun Yang, Wim van der Hoek, Maigeng Zhou, Boguang Wang, Liselotte van Asten, Qiyong Liu, Metamedica, and RS: CAPHRI - R4 - Health Inequities and Societal Participation
Subjects: Distributed lag, AMBIENT-TEMPERATURE, China, Hot Temperature, 010504 meteorology & atmospheric sciences, 010501 environmental sciences, 01 natural sciences, Biochemistry, DISEASE, Beijing, RISK-FACTOR, Risk of mortality, medicine, GLOBAL CLIMATE-CHANGE, Humans, Risk factor, Cities, Ambient temperature, Stroke, Diurnal temperature range, PLATELET, METAANALYSIS, 0105 earth and related environmental sciences, General Environmental Science, Cause of death, Aged, business.industry, MORTALITY, Diurnal temperature variation, Temperature, medicine.disease, Stroke in China, Cold Temperature, Temperature variation, Female, HEALTH, business, BURDEN, Demography, PACKAGE
Abstract: Background Stroke is the second leading cause of death in the world. It has multiple risk factors of which some, such as ambient temperature, are less well documented. Objective We aimed to examine the association between diurnal temperature range (DTR) and stroke mortality, and to test the possible effect modification of this association according to gender, age and educational level. Methods Daily data on weather and stroke mortality from 16 provincial capital cities in China for the years 2007–2013 were obtained, with a total of 788,783 deaths from stroke. A quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the city-specific DTR effect on stroke mortality. The pooled effects of DTR on stroke mortality were then obtained using a meta-analysis, which was based on restricted maximum likelihood estimation. Results The DTR impacts were generally limited to a period of eight days, while significant effects during lag 0–8 days were only found in the cities of Beijing, Zhengzhou, Nanjing, Hefei, Chongqing and Changsha. The DTR effects were significantly and negatively associated with latitudes at lag 0–10 days (rs = − 0.640, P = 0.008). An increase of 1 °C in DTR was associated with pooled estimate of 0.66% (95%CI: 0.28–1.05%), 0.12% (− 0.26% to 0.51%) and 0.67% (0.26–1.07%) increases in stroke mortality at lag 0–10 days during the total, hot and cold days, respectively. The impact of DTR was much higher in southern China than in northern China [1.02% (0.62% to 1.43%) versus 0.10% (-0.27% to 0.47%) ]. For the individual characteristics, only females, the elderly aged ≥ 65 years, and those with lower educational attainment were vulnerable to DTR. Conclusions DTR has considerable effects on risk of mortality from stroke in various cities in China, especially among the elderly, females, those with low educational level, and people living in southern China. The results can inform decisions on developing programs to protect vulnerable subpopulations from adverse impacts of DTR.
Published: 2018

48. Burden of Ischaemic heart disease and attributable risk factors in China from 1990 to 2015: findings from the global burden of disease 2015 study

Author: Yunquan Zhang, Chuanhua Yu, Maigeng Zhou, Ganshen Zhang, Lisha Luo, and Lu Wang
Subjects: Male, China, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, Psychological intervention, Myocardial Ischemia, 030204 cardiovascular system & hematology, Risk Assessment, Disability-adjusted life years, 03 medical and health sciences, Disability Evaluation, 0302 clinical medicine, Age Distribution, Cost of Illness, Environmental health, Cause of Death, Prevalence, Population growth, Medicine, Humans, 030212 general & internal medicine, Mortality, Population Growth, Life Style, Cause of death, Aged, Ischaemic heart disease, business.industry, Mortality rate, Incidence, Bayes Theorem, Health Status Disparities, Risk factors, lcsh:RC666-701, Attributable risk, Quality of Life, Female, Quality-Adjusted Life Years, Cardiology and Cardiovascular Medicine, business, Risk assessment, Research Article
Abstract: Background Ischaemic heart disease (IHD) is a major barrier to sustainable human development, but its health burden and geographic distribution among provinces of China remain unclear. This study aimed to estimate IHD burden in provinces of China, and attributable to risk factors from 1990 to 2015. Methods Data were collected from the Global Burden of Disease 2015 Study, which evaluated IHD burden and attributable risk factors using deaths and disability-adjusted life years (DALYs). Statistical models including cause of death ensemble modelling, Bayesian meta-regression analysis, and comparative risk assessment approaches were applied to reduce bias and produce comprehensive results of IHD deaths, DALYs and attributable risks. The 95% uncertainty intervals (UIs) were calculated and reported for mortality and DALYs. Results The age-standardised death rate per 100,000 people increased by 13.3% from 101.3 (95%UI: 95.3–107.5) to 114.8 (95%UI: 109.8–120.1) from 1990 to 2015 in China, whereas the age-standardised DALY rate declined 3.9% to 1760.2 per 100,000 people (95%UI: 1671.6–1864.3). In 2015, the age-standardised death rate per 100,000 people was the highest in Heilongjiang (187.4, 95%UI: 161.6–217.5) and the lowest in Shanghai (44.2, 95%UI: 37.0–53.1), and the age-standardised DALY rate per 100,000 people was the highest in Xinjiang (3040.8, 95%UI: 2488.8–3735.4) and the lowest in Shanghai (524.4, 95%UI: 434.7–638.4). Geographically, the age-standardised death and DALY rates for southern provinces were lower than northern provinces, especially in southeastern coastal provinces. 95.3% of the IHD burden in China was attributable to environmental, behavioural and metabolic risk factors. The five leading IHD risks in 2015 were high systolic blood pressure, high total cholesterol, diet high in sodium, diet low in whole grains, and smoking. Conclusions Population growth and ageing has led to a steady increase in the IHD burden. Regional disparities in IHD burden were observed in provinces of China. The distribution characteristics of IHD burden provide guidance for decision makers to formulate targeted preventive policies and interventions. Electronic supplementary material The online version of this article (10.1186/s12872-018-0761-0) contains supplementary material, which is available to authorized users.
Published: 2018

49. Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked

Author: Maigeng Zhou, Karen Eggleston, Shiwei Liu, M. Kate Bundorf, and Sen Zhou
Subjects: Adult, Rural Population, China, Economic growth, Insurance, Health, 030503 health policy & services, Health Policy, Mortality rate, Population health, Disease control, Insurance Coverage, 03 medical and health sciences, 0302 clinical medicine, Geography, Health spending, Health insurance, Humans, Rural Health Services, 030212 general & internal medicine, Mortality, 0305 other medical science, Demography
Abstract: Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004-12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage.
Published: 2017

50. Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities

Author: Jennifer A. Ross, Lijun Wang, Lap A. Tse, Xia Meng, Maigeng Zhou, Haidong Kan, Zhuohui Zhao, Peng Yin, Cong Liu, Xiaohui Xu, and Renjie Chen
Subjects: Pulmonary and Respiratory Medicine, China, 010504 meteorology & atmospheric sciences, Fine particulate, Names of the days of the week, Air pollution, 010501 environmental sciences, Critical Care and Intensive Care Medicine, medicine.disease_cause, complex mixtures, 01 natural sciences, Moving average, Air Pollution, Environmental health, medicine, Humans, Cities, Mortality, 0105 earth and related environmental sciences, Time trends, business.industry, Potential effect, Generalized additive model, Bayes Theorem, Cardiovascular Diseases, Particulate Matter, business
Abstract: Rationale: Evidence concerning the acute health effects of air pollution caused by fine particulate matter (PM2.5) in developing countries is quite limited.Objectives: To evaluate short-term associations between PM2.5 and daily cause-specific mortality in China.Methods: A nationwide time-series analysis was performed in 272 representative Chinese cities from 2013 to 2015. Two-stage Bayesian hierarchical models were applied to estimate regional- and national-average associations between PM2.5 concentrations and daily cause-specific mortality. City-specific effects of PM2.5 were estimated using the overdispersed generalized additive models after adjusting for time trends, day of the week, and weather conditions. Exposure–response relationship curves and potential effect modifiers were also evaluated.Measurements and Main Results: The average of annual mean PM2.5 concentration in each city was 56 μg/m3 (minimum, 18 μg/m3; maximum, 127 μg/m3). Each 10-μg/m3 increase in 2-day moving average of PM2.5 concentrat...
Published: 2017

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