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OBJECTIVE: In recent years, many researchers have taken serum ubiquitin c-terminal hydrolase (Uch-L1) as an indicator of post-traumatic brain injury and associated it with cognitive impairment. Alzheimer’s disease is characterized by cognitive impairment and energy metabolism disorders. The purpose of this study was to detect whether serum Uch-L1 is related to cognition and brain energy metabolism in healthy people, and to explore whether it can be used as an early blood marker of Alzheimer’s disease. PATIENTS AND METHODS: In this prospective cohort study, adult outpatients from a Grade 3A hospital were recruited. They completed the 18F-FDG-PET/CT examination in the nuclear medicine department and were screened by the Mini Mental State scale (MMSE) and the Montreal Cognitive Assessment scale (MoCA). Blood samples were collected from all outpatients to detect the concentration of serum Uch-L1, and the mean standard uptake value (SUVmean) of energy metabolism in the hippocampus during PET/CT examination was collected. RESULTS: A total of 37 participants, 14 participants with cognitive impairment (MMSE score < 27) and 23 controls (MMSE score 27-30) were included. There was a significant difference in the SUVmean of the hippocampus between the cognitive impairment group and the normal control group (p < 0.05). There was a significant correlation between the SUVmean of the hippocampus and the total score of MMSE in all participants [r = 0.439, 95% CI: (0.139-0.668), p = 0.007]. There were also significant correlations between serum Uch-L1 and MMSE. Based on the significant differences of demographic variables between groups, we conducted a multivariate linear regression analysis of MMSE cognitive scores based on age (X1), length of education (X2) and SUVmean of hippocampus (X3). The regression equation is as follows: Y = 25.709-0.072 X1 + 0.422 X2 + 0.232 X3. CONCLUSIONS: Brain cognitive ability is closely related to energy metabolism and serum Uch-L1 concentration, so serum Uch-L1 may become a blood marker for extensive screening of dementia in the future. We look forward to the introduction of a more accurate and low-cost method for detecting serum Uch-L1 concentration. [ABSTRACT FROM AUTHOR]

This paper aims to study the effects of lead concentration in irrigation water on the yield and growth traits of rice under soil zeolite stress, with the addition of lead accumulation in rice plants, which were tested in a micro zone at the Experimental Base of Water Conservancy in Shenyang Agricultural University of Liaoning Province, China, through the application of different amounts of zeolite (0, 2500, 5000kg·ha-1) and different lead concentrations (0, 0.25, 0.2, 0.15 mg·L-1) in irrigation water. It was concluded that the lead contents in paddy root, stem, leaf and rice significantly varied with different exogenous lead concentrations. With the increase of the concentration, the lead contents in each part were significantly increased. More importantly, the effect on aboveground material weight was greater than that on underground material weight. The water contents of rice were increased with the decrease in the protein content, and starch content was decreased under zeolite stress. When the concentration of lead increased, the effect was more pronounced. Comprehensive test with various factors indicated that the incorporation of zeolite in soil for rice cultivation with lead-contaminated water irrigation or lead contaminated soil could restrain the movement of lead ions into the rice. [ABSTRACT FROM AUTHOR]

Nowadays, nonpoint source pollution has been a dominant cause of water quality deterioration and eutrophication. For large basins, long-term effects of ecological factors on nonpoint source pollution are significant and have gained worldwide attention. Yangtze River is the largest river in China, and water environment protection of its upper reach is crucial to maintain the whole river health and the Three Gorges Project successful operation. The objective of this study is to reveal the effects of ecological factors on nonpoint source pollution in the upper reach of the Yangtze River during the period from 1960 through 2003 by the Improved Export Coefficient Model and the Nutrient Losses Empirical Model. The results indicated that during those decades the effects of ecological factors on dissolved pollutants were constant whereas those on sediment as well as absorbed pollutants changed slightly and decreased obviously after 2000. Comparing to anthropogenic factors, ecological ones had a dominant influence on sediment and absorbed pollutants. As for load intensities, long-term effects of ecological factors on dissolved pollutants hadn't changed much, while those on sediment as well as absorbed pollutants was increasingly significant and then reached an ultimate in 1980. Atmospheric deposition, grassland as well as forest were important sources of dissolved nitrogen export, nevertheless, grassland and forest were the main export areas of dissolved phosphorus, sediment as well as absorbed pollutants. The study would facilitate the source identification and nonpoint source pollution control in the upper reach of the Yangtze River to improve water quality. [ABSTRACT FROM AUTHOR]

We report the release of a new, largefruited kiwifruit cultivar, 'White', selected from Actinidia eriantha. Fruit of 'White' had a mean fruit weight of 94 g, and a maximum fruit weight of 132 g at harvest in Zhejiang, China. The mean fruit weight is c. 2-4 times that of wild A. eriantha fruit found in Zhejiang and nearly 4 times that of 'Bidan', the only other registered A. eriantha cultivar. The fruit are oblong and the peelable skin is covered with dense white hair. The flesh of ripe fruit is green and has good eating quality but little juice. The soluble solids concentration was 14.7%, total sugar 9%, total acid 1.24%, and vitamin C 628.37 mg/100 g fresh weight. Its harvest season is during the last 10 days of October in the south of Zhejiang province, which is c. 2 weeks later than A. deliciosa 'Bruno' in the same area. It is sometimes referred to as the "banana kiwifruit" because the skin is easy to peel. This new cultivar has been registered in China (PVR No. CNA20050673.0). [ABSTRACT FROM AUTHOR]

Objective: To explore the trends and distribution of liver cancer between sexes, ages, and urban-rural areas in Tianjin, China from 1999 to 2021, and provide data for targeted prevention and control strategies of liver cancer in Tianjin. Methods: Liver cancer mortality data of Tianjin during 1999-2021 were from the Tianjin population based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC), and the population data of permanent Tianjin residents were from Tianjin Municipal Public Security Bureau. Liver cancer mortality, years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALY) were calculated using the cause of death surveillance data collected by Tianjin Centers for Disease Control and Prevention. The distributions of these data among residents of different sexes, ages, and regions were analyzed. Segi's world standard population was used for standardization. Joinpoint regression was used for trend analysis on the mortality rate of liver cancer and the disease burden. Results: The liver cancer mortality rate in Tianjin decreased by 46.75% from 1999 to 2021, with distinct phased characteristics. From 1999 to 2010, the age-sex-standardized mortality rate (SMR) decreased from 12.62/100 000 to 11.64/100 000 with an annual percent change (APC) of -1.32% ( P =0.003). From 2010 to 2021, the SMR decreased from 11.64/100 000 to 6.72/100 000 (APC=-3.89%, P ＜0.001). The age-sex-standardized DALY rates(SDR) decreased by 50.63% from 1999 to 2021, also with distinct phased characteristics. From 1999 to 2010, the SDR decreased from 388.67/100 000 to 349.38/100 000 (APC=-1.35%, P =0.002). From 2010 to 2021, the SDR decreased from 349.38/100 000 to 191.88/100 000 (APC=-4.43%, P ＜0.001). The liver cancer mortality rate declined most rapidly in the age group under 45 years; the APC for those under 35 years was -5.07% ( P ＜0.001), and for those aged 35-44 years, the APC was 0.63% ( P =0.707) and -8.21% ( P ＜0.001) before and after 2007, respectively. Both SMR and SDR were significantly higher in males than in females ( P ＜0.01). Both SMR and SDR were significantly higher in urban areas than in rural areas from 1999 to 2007 ( P ＜0.05), but they became similar after 2008. Liver cancer DALY are predominantly YLL, accounting for 99%. The median age of liver cancer deaths in Tianjin during 1999-2021 was 64-68 years old, with males lower than females ( P ＜0.05), and rural areas lower than urban areas ( P ＜0.05), generally showing an increasing trend (1999-2014: APC=0.11%, P =0.047; 2014-2021: APC=0.51%, P =0.005). Conclusions: Liver cancer mortality rate and disease burden decreased from 1999 to 2021 in Tianjin, with an especially accelerated decline after 2010. Further efforts to reduce liver cancer mortality in Tianjin are needed, and special attention should be focused on the elderly, male, and rural residents.

Objective: To describe the distribution characteristics of hyperlipidemia in adult twins in the Chinese National Twin Registry (CNTR) and explore the effect of genetic and environmental factors on hyperlipidemia. Methods: Twins recruited from the CNTR in 11 project areas across China were included in the study. A total of 69 130 (34 565 pairs) of adult twins with complete information on hyperlipidemia were selected for analysis. The random effect model was used to characterize the population and regional distribution of hyperlipidemia among twins. The concordance rates of hyperlipidemia were calculated in monozygotic twins (MZ) and dizygotic twins (DZ), respectively, to estimate the heritability. Results: The age of all participants was (34.2±12.4) years. This study's prevalence of hyperlipidemia was 1.3% (895/69 130). Twin pairs who were men, older, living in urban areas, married,had junior college degree or above, overweight, obese, insufficient physical activity, current smokers, ex-smokers, current drinkers, and ex-drinkers had a higher prevalence of hyperlipidemia ( P <0.05). In within-pair analysis, the concordance rate of hyperlipidemia was 29.1% (118/405) in MZ and 18.1% (57/315) in DZ, and the difference was statistically significant ( P< 0.05). Stratified by gender, age, and region, the concordance rate of hyperlipidemia in MZ was still higher than that in DZ. Further, in within-same-sex twin pair analyses, the heritability of hyperlipidemia was 13.04% (95% CI : 2.61%-23.47%) in the northern group and 18.59% (95% CI : 4.43%-32.74%) in the female group, respectively. Conclusions: Adult twins were included in this study and were found to have a lower prevalence of hyperlipidemia than in the general population study, with population and regional differences. Genetic factors influence hyperlipidemia, but the genetic effect may vary with gender and area.

Objective: To describe the distribution characteristics of hypertension among adult twins in the Chinese National Twin Registry (CNTR) and to provide clues for exploring the role of genetic and environmental factors on hypertension. Methods: A total of 69 220 (34 610 pairs) of twins aged 18 and above with hypertension information were selected from CNTR registered from 2010 to 2018. Random effect models were used to describe the population and regional distribution of hypertension in twins. To estimate the heritability, the concordance rates of hypertension were calculated and compared between monozygotic twins (MZ) and dizygotic twins (DZ). Results: The age of all participants was (34.1±12.4) years. The overall self-reported prevalence of hypertension was 3.8%(2 610/69 220). Twin pairs who were older, living in urban areas, married, overweight or obese, current smokers or ex-smokers, and current drinkers or abstainers had a higher self-reported prevalence of hypertension ( P <0.05). Analysis within the same-sex twin pairs found that the concordance rate of hypertension was 43.2% in MZ and 27.0% in DZ, and the difference was statistically significant ( P <0.001). The heritability of hypertension was 22.1% (95% CI : 16.3%- 28.0%). Stratified by gender, age, and region, the concordance rate of hypertension in MZ was still higher than that in DZ. The heritability of hypertension was higher in female participants. Conclusions: There were differences in the distribution of hypertension among twins with different demographic and regional characteristics. It is indicated that genetic factors play a crucial role in hypertension in different genders, ages, and regions, while the magnitude of genetic effects may vary.

Objective: To examine the heritability of body mass index (BMI) and coronary heart disease (CHD), and to explore whether genetic factors can explain their correlation. Methods: Participants were from 11 provinces/municipalities reqistered in the Chinese National Twin Registry (CNTR) from 2010 to 2018. Participants data were collected from face-to-face questionnaire survey. Bivariate structure equation model was used to estimate the heritability and the genetic correlation of BMI and CHD. Results: A total of 20 340 pairs of same-sex twins aged ≥25 years were included in this study. After adjusting for age and gender, the heritability of BMI and CHD was 0.52 (95% CI : 0.49-0.55) and 0.76 (95% CI : 0.69-0.81), respectively. Further, a genetic correlation was identified between BMI and CHD ( r A =0.10, 95% CI :0.02-0.17). Conclusion: In Chinese adult twin population, BMI and CHD are affected by genetic factors, and their correlation can be attributed to the common genetic basis.

Objective: To explore the gene-lifestyle interaction on coronary heart disease (CHD) in adult twins of China. Methods: Participants were selected from twin pairs registered in the Chinese National Twin Registry (CNTR). Univariate interaction model was used to estimate the interaction, via exploring the moderation effect of lifestyle on the genetic variance of CHD. Results: A total of 20 477 same-sex twin pairs aged ≥25 years were recruited, including 395 CHD cases, and 66 twin pairs both had CHD. After adjustment for age and sex, no moderation effects of lifestyles, including current smoking, current drinking, physical activity, intake of vegetable and fruit, on the genetic variance of CHD were found ( P >0.05), suggesting no significant interactions. Conclusion: There was no evidence suggesting statistically significant gene-lifestyle interaction on CHD in adult twins of China.

Objective: To investigate the mortality trends of road traffic injury in Tianjin from 2000 to 2019, understand the mortality of road traffic injury in different populations and provide evidence for the prevention and control of road traffic injury. Methods: Mortality data of road traffic injury in Tianjin during 2000-2019 were collected from the Population Based Mortality Surveillance System in Tianjin. Population data of permanent residents were collected from Tianjin Municipal Public Security Bureau. The crude mortality rate, the Chinese age-standardized rates, and premature mortality probability and gender and area specific constituent ratio were calculated. The trends in different populations were analyzed by using Joinpoint regression analysis. The average annual percent change (AAPC) and annual percent change (APC) were calculated. Results: From 2000 to 2019, a total of 26 919 deaths due to road traffic injury occurred in Tianjin. The death constituent ratio decreased from 21.28% to 18.38% in urban males and the death constituent ratio in urban women declined from 7.01% to 6.28%. The death constituent ratio declined from 59.16% to 55.59% in rural males, whereas the death constituent ratio in rural women increased from 12.55% to 19.75%. From 2000 to 2019, the crude mortality rate of road traffic injury declined from 14.08/100 000 to 7.89/100 000, and the age-standardized mortality declined from 13.28/100 000 to 5.51/100 000. The probability of premature mortality was 0.70% in 2000 and 0.38% in 2019. The mortality rate and premature mortality probability of road traffic injury increased first, then decreased slightly and then decreased rapidly. The mortality of road traffic injury increased with age. From 2000 to 2019, the mortality of road traffic injury in males was higher than in females, but showed a rapid decline. The age-standardized mortality rate was 20.97/100 000-8.01/100 000 in males, and 5.10/100 000-2.85/100 000 in females. Compared with the urban area, the mortality rate in rural area was higher, but declined more rapidly in recent years. The age-standardized mortality rate decreased from 6.99/100 000 to 2.46/100 000 in urban area, and from 19.85/100 000 to 8.75/100 000 in rural area. As the population with the highest mortality of road traffic injury, the morality rate in males in rural area had decreased rapidly since 2016, the APC of age-standardized mortality rate from 2016 to 2019 was -18.55%. Conclusions: The effect of the road safety promotion in Tianjin was significant. The mortality of road traffic injury showed a downward trend, especially in recent years. It is necessary to strengthen the prevention and control of rode traffic injury in males, rural residents and elderly people.

Objective: To explore the gene-body mass index (BMI) interaction on coronary heart disease (CHD) in the Chinese adult twins. Methods: A total of 20 340 same-sex twin pairs registered in the Chinese National Twin Registry (CNTR) were enrolled in this study. Classical twin structure equation model was used to estimate the gene-BMI interaction on CHD. Results: After adjusting for age, we found that genetic variance of CHD differed as the function of BMI in male twins, which indicated the presence of a gene-BMI interaction on CHD ( P =0.008).The genetic moderating effect ( β a ) was -0.14 (95% CI : -0.22--0.04), indicating that for each logarithmic transformation value of BMI increase, genetic path parameters would decrease by 0.14, which would result in the decrease of genetic variance of CHD. And the heritability of CHD was 0.77 (95% CI : 0.65-0.86) among the male twins with lower BMI (<24.0 kg/m 2 ), but 0.56 (95% CI : 0.33-0.74) among the male twins with high BMI (≥24.0 kg/m 2 ). However, there was no evidence suggesting that BMI could moderate genetic variants of CHD in female. Conclusion: We found a significant gene-BMI interaction on CHD in the Chinese male adult twins in China, and the heritability of CHD was higher among the twins whose BMI was <24.0 kg/m 2 .

Objective: To explore the incidence characteristics of hemorrhagic stroke among residents in Tianjin from 1999 to 2018, to provide data for formulating accurate prevention and control strategies. Methods: The incidence rate of hemorrhagic stroke and its distribution in different ages, gender, urban and rural areas were analyzed by monitoring new hemorrhagic stroke cases in Tianjin from 1999 to 2018. The standardized incidence rate was calculated based on the six th national population census in 2010. χ 2 test was used to compare the incidence rate. The trend of age and trend of age were analyzed by trend χ 2 test. Joinpoint software was used to analyze the change in the annual incidence rate. Results: During the study period, hemorrhagic stroke accounted for 13.08% of all stroke cases. The incidence rate of a hemorrhagic stroke in Tianjin residents was 75.38/100 000-46.70/100 000, showing a downward trend ( Z =-28.63, P <0.01, APC=-1.45%). After adjustment of age and gender, the standardized rate was 57.93/100 000-27.55/100 000, still showing a downward trend ( Z =-54.72, P <0.01, APC=-3.38%). The incidence rate of male and female hemorrhagic stroke decreased, and the incidence rate of males in all ages and age groups was higher than that in females ( P <0.01). The age of onset is younger, and the standardized incidence rate of an urban hemorrhagic stroke in the city decreases ( P <0.01), and the city descends faster. Conclusions: The characteristics of hemorrhagic stroke in Tianjin are similar to those in developed countries. The lower age group and rural population are the key groups of intervention. The study of incidence characteristics and trends is of great significance for accurate prevention and control of stroke, reducing disease and medical costs.

Objective: To describe the differences in body mass index (BMI) distribution in adult twins registered in Chinese National Twin Registry (CNTR), and provide evidence for the risk factor analysis and prevention and control of overweight or obesity. Methods: A total of 32 725 twin pairs aged 18 years and above who completed the questionnaire survey during 2010-2018 and had complete registered information in CNTR and normal body weight and length were included in the analysis on the population and region specific distributions of BMI of twin pairs and the difference in BMI in twin pairs. Results: The twin pairs included in the analysis were aged (34.6±12.4) years, the twin pairs of same gender accounted for 79.7%. The average BMI was 22.5 kg/m 2 . The overall prevalence of obesity and overweight was 4.9% and 23.7%, respectively. Participants who were men, 50-59 years old, married, had lower education level, and lived in northern China had higher overweight rate and obesity rate ( P <0.001). The difference in overweight or obesity prevalence between monozygotic (MZ) twin pars and dizygotic (DZ) twin pairs was not significant, but firstborn twin pairs had slightly higher rates of overweight and obesity than later-born twin pairs ( P <0.05). The analysis in same gender-twin pairs indicated that the difference in BMI was associated with age (trend test: P <0.001), and the difference was more obvious in DZ twin pair in MZ pair and this difference increased with age. The concordant rate of BMI was higher in MZ twin pairs than DZ twin pairs ( P <0.05). Conclusion: The distribution of BMI of twin pairs varied with population and region and BMI varied with age due to its genetic nature.

Objective: To understand the influence of birth weight on the risk of chronic diseases, such as hypertension and diabetes, and the relationship between birth weight and serum uric acid in adulthood. Methods: According to the Chinese Adult Chronic Disease and Nutrition Surveillance Program, a total of 1 131 residents aged 18 years and above were enrolled from Hexi, Nankai, Hongqiao, Wuqing, Jinnan, Baodi and Jizhou districts of Tianjin. The data of birth weight and blood pressure of the residents were collected, and fasting venous blood samples were collected from them to detect uric acid, blood glucose and blood lipids levels. The distribution of birth weight of the surveyed population was described, and the relationship between birth weight and chronic diseases, such as hypertension and diabetes, and the blood uric acid level in adulthood were analyzed. Results: The average birth weight of the surveyed population in Tianjin was 3.37 kg, which was higher in males than in females. No matter overweight/obesity, hypertension or diabetes, the prevalence rate of normal birth weight was the lowest in adulthood. After univariate logistic regression analysis and adjusting for age, sex, smoking and drinking status, it was found that compared with normal birth weight, low birth weight had a stronger correlation with diabetes ( OR =2.91,95% CI :1.46-5.76) and dyslipidemia ( OR =1.79,95% CI :1.01-3.19) in adulthood. Macrosomia was strongly associated with overweight/obesity in adulthood ( OR =1.47, 95% CI :1.08-2.01). There was no significant difference in serum uric acid level among the residents with different birth weights. Conclusions: The low birth weight of the surveyed population in Tianjin was closely related to the risk of diabetes and dyslipidemia in adulthood, and the macrosomia was closely related to the risk of overweight/obesity in adulthood.

Objective: To explore the modification effect of physical activity on the genetic effects of type 2 diabetes mellitus (T2DM). Methods: The univariate moderation model was fitted to calculate the modifying effect of physical activity on the genetic effects of T2DM based on the data of 12 107 pairs of same gender twins aged 30 years and older enrolled by the Chinese National Twin Registry in 11 provinces/cities in China. Results: After adjusting for age and gender, the heritability of T2DM was 0.56 (0.31-0.84). Qualified physical activity could attenuate the genetic effects of T2DM. The heritability of T2DM in twin pairs with qualified physical activity was 0.46 (0.06-0.88), which was lower than that in twin pairs without qualified physical activity during the same model [0.68(0.36-0.94)]. Conclusion: T2DM is a moderate genetic disease, physical activity can modify the genetic effects of T2DM.

Objective: Diet balance index (DBI&#95;16) was used to evaluate the dietary status of smoking adults in Tianjin, and the relationship between DBI&#95;16 and serum uric acid was analyzed. Methods: A total of 1 478 inhabitants aged 18 and above were enrolled. The dietary status was obtained with a 3-day dietary recall and condiment weighing method. And their fasting venous blood was collected to detect uric acid. Food intake and DBI&#95;16 scores of smokers and non-smokers were described, and the relationship among smoking, diet quality distance (DQD-DBI), and serum uric acid was analyzed. Results: The intake of vegetables, fruits, and milk of smokers in Tianjin was lower than while the salt, oil, cereals, and aquatic products were higher than that of non-smokers. The DBI&#95;16 scores of vegetables and fruits, food types, milk, and beans of smokers were lower than those of non-smokers in Tianjin, and the scores of pure energy foods and condiments were higher than those of the non-smokers. The DQD-DBI, high bound score and low bound score of smokers in Tianjin were 42.0, 14.0, and 29.0 respectively, which were all higher than those of non-smokers. The main problems appeared as moderately inadequate intake (accounting for 67.0%), low, excessive intake (accounting for 70.9%), and moderate imbalance of intake (accounting for 67.2%). The serum uric acid of smokers was higher than in the non-smokers, and there the same result appeared under the conditions of "not suitable" in DQD-DBI. Conclusions: In Tianjin, the dietary imbalance was more evident in smokers than the non-smokers, and the serum uric acid was significantly higher than the non-smokers. Strategies as strengthening the nutrition education and intervention targeted for smokers were in urgent need.

Objective: To assess the trend and the factors responsible for the increase of life expectancy of residents in Tianjin over the past two decades. Methods: Abridged Life Table and Arriaga's decomposition method was applied to quantify the influence of the age structure and the leading causes of death on the increase of life expectancy of residents in Tianjin from 1999 to 2018. Results: In the past 20 years, the life expectancy of residents in Tianjin increased by 4.97 years, the life expectancy of men and women increased by 4.11 years and 5.86 years, respectively. The decrease of mortality rate in 0-year-old group contributed 19.17% to the increase of the life expectancy, while the decrease of mortality rate in residents aged ≥55 years contributed more to the increase of life expectancy, with the cumulative contribution rate of 67.38%. The major contribution to the increase of life expectancy was the mortality reduction of cerebrovascular disease, respiratory disease, cardiovascular disease, perinatal diseases, congenital malformations and injury, with the contribution percentage of 27.27%, 21.37%, 15.76%, 12.22%, 6.44% and 4.86%, respectively. The increase of mortality of malignant tumor, injury and poisoning, diabetes and nervous system diseases and others had a negative effect on the increase of life expectancy of people aged ≥75 years. From 1999 to 2018, the life expectancy increased from 76.72 years to 81.46 years ( t =9.11, P <0.001), the annual percent change (APC) was 0.58%. From 2011 to 2018, it was stable, ranging from 81.46 years to 81.69 years ( t =0.89, P =0.387, APC=0.13%). Conclusion: From 1999 to 2018, the increase of life expectancy was attributed to the decrease of mortalities in infants and the elderly and the decrease of mortalities of cerebro-cardiovascular disease, respiratory disease, perinatal disease, congenital malformations and injury. However, these positive contributions were partly offset by the negative contribution of malignant tumor, injury, diabetes and nervous system disease in those aged ≥75 years. Comprehensive prevention and control of key diseases should be strengthened in key population in order to further improve the life expectancy of the population.

Objective: To analyze the characteristics of newly reported HIV/AIDS cases in medical institutions in Tianjin from 2005 to 2017 and provide evidence for the improvement of AIDS prevention and treatment in medical institutions. Methods: The data of the newly reported cases of HIV/AIDS in medical institutions in Tianjin from 2005 to 2017 were analyzed. Meanwhile a retrospective survey was conducted on the source department of medical institutions and the main disease for treatment of HIV/AIDS cases. Results: A total of 3 035 HIV/AIDS cases were reported in medical institutions in Tianjin from 2005 to 2017 with an annual increase of 24.8 % , among these cases, 49.2 % (1 343/2 728) were reported from inpatients and 50.8 % (1 385/2 728) were reported from outpatients. There was an increasing trend in the HIV positive detection rate in STD outpatients from 2011 to 2017 ( χ (2)=18.469, P =0.005). The counts of the first CD(4)(+) T cell counts (CD(4)) ( χ (2)=17.189, P =0.000) among the cases from inpatients and outpatients and the proportions of deaths in the year when the cases were found differed ( χ (2)=61.198, P =0.000), the differences were significant. And the statistically significant differences in the counts of the first CD(4) ( χ (2)=16.751, P =0.000) and the proportions of deaths in the year when the cases were found ( χ (2)=18.926, P =0.000) existed among the cases in grade Ⅲ hospitals and in grade Ⅱ hospitals; meanwhile the differences in the counts of the first CD(4) ( χ (2)=37.620, P =0.000) and the proportions of deaths in the year when the cases was found ( χ (2)=95.489, P =0.000) among the cases from different departments were significant. Conclusion: The timeliness of HIV/AIDS case reporting by outpatient departments was better in medical institutions in Tianjin, and the case reporting in grade Ⅱ hospitals were more timely than in grade Ⅲ hospitals; so it is suggested to provide active HIV test in key departments of medical institutions for the better HIV/AIDS prevention and control in Tianjin.

Objective: To analyze the trends of mortality and years of life lost (YLL) of breast cancer in women in Tianjin and provide references for the development of intervention strategies. Methods: The crude mortality rate, standard mortality rate, cumulative rate (0-74 years old) and truncated rate (35-64 years old) of breast cancer in women in Tianjin from 1999 to 2017 were calculated. The annual percentage change of the mortality rate and YLL rate were analyzed by Joinpoint regression. Results: From 1999 to 2017, a total of 8 356 deaths of breast cancer were reported in Tianjin, resulting in a YLL of 262 835.53 person-years. The average crude mortality rate was 9.15/100 000. The average age standardized rate(ASR) (World) was 6.14/100 000. The ratio of ASR (World) between urban and rural areas was 1.73∶1. The peak mortality ratio of age groups between urban area and rural area was 3.13∶1. From 1999 to 2017, both the crude mortality rate and ASR of breast cancer in Tianjin had rising trends. In 2017, the crude mortality rate and the ASR of breast cancer increased by 113.7% and 44.4% respectively compared with 1999. The increase of urban mortality mainly came from elderly group aged ≥75 years, and the mortality of young age groups in rural area showed an fast increases, which was most obvious in age group 45-59 years (average annual percentage change=3.6%, P <0.01). Conclusions: The mortality rate of breast cancer and disease burden in women in Tianjin are still in rapid increase. We should continue to implement the prevention and control strategies such as lifestyle intervention and screening of key groups. More attention need to be paid to the increase of breast cancer incidence in rural area.

Objective: To explore the genetic and environmental effects on alcohol intake. Methods: Data on 9 231 pairs of adult twins of the same sex was collected from the Chinese National Twin Registry (CNTR), between 2015 and 2018 and used in this study. Structural equation model was used to estimate the effects of genetic and environmental factors on alcohol intake. Results: A total of 9 231 pairs of twins were included in the analysis, of which 6 085 pairs were monozygotic (MZ). The average age of MZ was (36.91±13.07) years old, and males accounted for 56.80 % . The average age of dizygotic twins (DZ) was (35.22±12.48) years old, and males accounted for 55.91 % . There were 350 pairs of alcohol-drinking twins were with high-risk, accounting for 1.90 % and another 367 pairs (1.99 % ) were with medium-risk. Alcohol-drinkers with medium-risk were affected by additive genetics, common and unique environmental factors, seen among the twins. The overall heritability appeared as 24.3 % (95 %CI : 0 to 56.8 % ). Furthermore, 50.7 % of the variation (95 %CI : 20.4 % -79.0 % ) could be explained by the common environmental factors and 24.9 % (95 %CI : 18.3 % -36.5 % ) by unique environmental factors. High-risk related drinking behavior was affected by both common and unique environmental factors. The common environmental component appeared as 75.6 % (95 %CI : 69.6 % -80.8 % ) and unique environmental component as 24.4 % (95 %CI : 19.2 % -30.4 % ), respectively. Gender difference was seen in the heritability of those with medium or high-risk drinking behaviors. The heritability of men was 30.8 % (95 %CI : 9.8 % -53.5 % ), while in women it was mainly affected by the environment. Conclusion: Both alcohol drinkers with medium and high-risk drinking behaviors were mainly affected by the environment factors and gender. With the increase of drinking volume, the effect of environment on drinking behaviors became more obvious.

Objective: To analyze the heritability of coronary heart disease (CHD) among the Chinese twin adults. Methods: A total of 20 477 same-sex twin pairs aged 25 years and older from the Chinese National Twin Registry were interviewed. Structure equation model was used to estimate the heritability of CHD. Results: After adjusting for age and gender, the overall heritability of CHD was 0.75(0.68-0.81). Stratified analyses showed that genetic factors play a more important role in CHD incidence in ≥40 years or female twins. While the development of CHD was mainly influenced by environmental factors in 25-39 years or male twins. Conclusion: CHD is influenced by both genetic and environmental factors and the heritability is high.

Objective: To quantitate the association between birth weight and phenotypes of physical indicators in adulthood, i.e. BMI and waist circumference (WC) and to what degree genetic or environmental factors affect birth weight-obesity association. Methods: A total of 6 623 gender matched twin pairs aged 25 to 79 years were recruited through the Chinese National Twin Registry. The twins reported their own birth weight, current height and weight, and WC using a self-administered questionnaire. BMI was calculated according to the self-reports of body height and weight. Within twin-pair design was used to quantitate the association between birth weight and phenotypes related to obesity while bivariate structural equation models were used to decompose the phenotype correlation. Results: After adjusted for multiple factors, twin-pair analyses within monozygotic (MZ) showed that, on average, a 1.0 kg increase in birth weight corresponded to an increase of 0.33 kg/m(2) in BMI and 0.95 cm in WC in adulthood ( P <0.001). Bivariate structural equation models showed significant positive unique environmental correlation between birth weight and the two obesity-related phenotypes. Conclusion: The study supported the role of twin-specific supply line factors on relationship between birth weight and physical indicators in adulthood.

Objective: To analyze the long-term trend of mortality and years of life lost (YLL) of gastric cancer in Tianjin from 1999 to 2015. Methods: From January 1, 1999 to December 31, 2015, the data of gastric cancer deaths was collected from the Tianjin death surveillance system. The inclusion criteria of death due to gastric cancer were coded by using 151 in the 9(th) edition of the international classification of diseases (ICD) (1999-2002) and C16 in the 10(th) edition of ICD (2003-2015). The crude and age-standardized mortality rate (ASR) of gastric cancer was calculated according to Segi's world standard population. YLL was calculated according to the standard method of the disease burden of WHO. The Joinpoint regression was used to calculate the average annual percentage change (AAPC) to indicate the trend of mortality and YLL of gastric cancer. Results: From 1999 to 2015, there were 20 000 deaths of gastric cancer in Tianjin. The proportion of gastric cancer death in the population aged 0-44 years old, 45-64 years old, and 65 years old and above was 4.9%, 30.4%, and 64.8%, respectively. The proportion of males and urban was 67.1% and 67.5%, respectively. From 1999 to 2015, the crude mortality rate was from 12.10/100 000 to 12.58/100 000. The ASR was from 11.04/100 000 to 7.24/100 000. The average annual YLL number was 29 625.83 person-years and the rate was 3.09 person-years per thousand people. From 1999 to 2015, the crude mortality rate and the PYLL of gastric cancer in Tianjin were stable (the AAPC was 0.34% and -0.24%, all P values >0.05). The ASR showed a downward trend (AAPC=-2.58%, P< 0.001). Conclusion: From 1999 to 2015, the ASR of gastric cancer in Tianjin showed a downward trend, and the YLL of gastric cancer was stable.

To explore the epidemiological characteristics, trends and relevant factors of pre-hospital mortality due to acute myocardial infarction (AMI) from 1999 to 2016 in Tianjin city, based on mortality surveillance information and household registration population information. Standardized mortality rates were calculated using the year 2000 world standard population. From 1999 to 2016, the research result showed that the pre-hospital crude mortality rates of AMI were 39.47/100 000 to 90.64/100 000 and the standardized mortality rates were 30.92/100 000 to 53.90/100 000. The proportion of pre-hospital AMI deaths was 73.96%-81.92% ( t= 1.09, P> 0.05) within the same period. Aged, female, rural residents, unmarried, divorced, widowed, low education level, and outdoor workers have a relative higher proportion of pre-hospital AMI mortality.

Objective: To understand the status and food sources of daily dietary intake of sodium and potassium among adult inhabitants in Tianjin city, and to compare the consistence of sodium and potassium intake determined by combination of 3 consecutive 24-hour recalls and weighing family condiments (3 d dietary survey method) with 24 h urine sodium and potassium determination. Methods: Multistage cluster sampling method was applied to select 1 955 adult inhabitants from 840 households of 7 districts in Tianjin in 2015. Questionnaire survey was used to obtain basic information, 3 d dietary method was used to obtain dietary information, and 450 subjects was selected by systematic random sampling method for 24 h urine collection and determination of sodium and potassium, and 153 complete 24 h urine samples were selected by the coefficient of urinary creatinine excretion, then the consistence of the determination was compared with 3 d dietary survey method. Results: 1 828 subjects were enrolled in this study with age of (54.6±14.7) years, among which 858 were male (46.9%). The average standard intake of sodium and potassium per people per day were (5 631.2±3 372.1) mg and (1 662.1±750.5) mg, while the average actual daily intake were (5 315.8±3 196.5) mg and (1 560.7±696.8) mg. 98.7% (1 804/1 828) of the subjects had dietary sodium intake exceeding the recommended adequate intake of China residents(1 300-1 500 mg/d), while 78.5% (1 435/1 828) consumed dietary potassium below the recommended adequate intake(2 000 mg/d). The main resource of sodium was condiments, among which cooking salt accounted for 61.5%, soy sauce accounted for 11.2%. Potassium mainly came from cereals (32.4%) and vegetables (18.1%). Compared with the 24 h urine sodium method, 3 d dietary method overestimated the sodium intake with a gap [median ( P (25), P (75))] as 401.7 (-1 130.6, 1 939.5) mg/d with statistical difference ( P< 0.05). The gap [median ( P (25)- P (75))] for potassium between the two methods was 79.1 (-577.5, 565.2) mg/d, without statistical difference ( P> 0.05). Conclusion: The dietary intake of sodium is high while potassium is low among adults inhabitants in Tianjin city. Compared with the 24 h urine sodium and potassium determination, the 3 d dietary method has a good consistency in evaluating the dietary potassium intake level of the population, but overestimates the dietary sodium intake.

Objective: To understand the status quo of smoking and change pattern of smoking related behaviors in the past 20 years in the urban adults in Tianjin. Methods: Data was from the study of Chinese Chronic Disease and Risk Factors (2015). Multi stage stratified random sampling method was used to conduct a questionnaire survey in 7 surveillance sites in Tianjin. Results: in the urban residents aged>20 years were compared with those in surveys in 1996 and 2010. Results In 2015, the smoking rate in men and women aged>20 years in Tianjin were 41.1 % and 4.5 % respectively. The average age of starting smoking was (19.2±4.7) years for men and (24.8±10.9) years for women, showing a younger age trend. Compared with the data from 1996 and 2010, the smoking rate in the urban residents was in decrease, but the rate of successful smoking cessation was in increase in 2015, the differences were significant. Conclusions: Since 1996, the rate of smoking in the urban residents of Tianjin has been in decline, however it is still at a high level, especially in women. The average age of starting smoking remains to be younger. It is necessary to strengthen the health education about harm of smoking in adolescents.

Objective: To investigate the mortality of colorectal cancer and its trend from 1999 to 2015 in Tianjin, China, and to explore the mortality features in different populations in order to provide data for prevention and control strategies of colorectal cancer. Methods: Colorectal cancer mortality data between 1999 and 2015 were collected from Tianjin population - based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC). Population data of permanent residents were collected from Tianjin Municipal Public Security Bureau. The number of new cases and deaths, incidence [including crude incidence, age-adjusted standardized incidence and 95% confidence interval (95% CI)], and mortality (including crude mortality, age-adjusted standardized mortality and 95% CI) of colorectal cancer were calculated. Standardized incidence and mortality of colorectal cancer were calculated using the Segi's world standard population, adjusted with age and gender. JoinPoint regression and Cochran-Armitage trend test were used to determine the statistical significance of differences in mortality trend. Results: A total of 31 376 new onset cases and 14 893 death cases of colorectal cancer were observed in Tianjin from 1999 to 2015. Colorectal cancer incidence increased from 1999 to 2015 with a standardized rate from 9.66/100 000 to 15.36/100 000 [annual percent change(APC)=3.48%, Z =23.21, P <0.001]. Colorectal cancer mortality increased from 1999 to 2015 with a standardized rate from 5.18/100 000 to 6.11/100 000 (APC=1.24%, Z =5.69, P <0.001). Both showed an increasing trend. The death proportion of colon cancer increased (39.67% in 1999 and 50.33% in 2015), while the death proportion of rectal caner decreased (60.33% in 1999 and 48.57% in 2015). The median age of colorectal cancer onset fluctuated steadily around 66 years old (APC=0.16, T =1.75, P =0.100); the median age of death increased from 69 to 73 years old (APC=0.43, T =8.81, P <0.001). From 1999 to 2015, the mortality of colorectal cancer showed a downward trend (all P <0.05) in the age groups of <35 and 35-44 years, while an upward trend (all P <0.05) in the age groups of 45-54 years, 55-64 years and ≥ 65 years. Colorectal cancer mortality in males increased with a standardized rate of 5.53/100 000 in 1999 to 7.33/100 000 in 2015(APC=2.29%, Z =7.86, P <0.001), while colorectal cancer mortality in females flatted with a standardized rate of 4.83/100 000 in 1999 to 4.89/100 000 in 2015 (APC=0.10%, Z =-0.30, P =0.752). Colorectal cancer mortality increased with a standardized rate of 6.75/100 000 in 1999 to 7.33/100 000 in 2015 (APC=0.54%, Z =1.98, P =0.048) in urban areas and of 3.18/100 000 in 1999 to 4.38/100 000 in 2015 (APC=2.47, Z =6.46, P <0.001) in rural areas, whose differences were significant. Standardized mortality rate in rural area was lower but the rising velocity was faster as compared to urban area. Conclusions: Crude mortality and standardized mortality of colorectal cancer increase from 1999 to 2015 in Tianjin population. The people of elder, male and urban area have higher mortality. The mortality in people of male and rural area presents a faster rising state. Further efforts to reduce colorectal cancer mortality in Tianjin are needed to prevention and control of colorectal cancer.

Objective: To analyze the heritability of diabetes among the Chinese twin adults. Methods: A total of 10 253 same-sex twin pairs aged 25 years and older, were selected from the Chinese National Twin Registry (CNTR) program. Heritability of diabetes was calculated by using the structural equation model. Results: After adjusted for age and gender, the overall heritability rates of diabetes were 0.41 (0.15-0.75), 0.83 (0.72-0.91) and 0.34 (0.04-0.73) in the <45 and ≥45 years twin pairs, respectively. After adjusted for age, rates of heritability appeared as 0.37 (0.05-0.78) and 0.88 (0.79-0.94) in men and women, respectively. Conclusions: Diabetes is affected by both genetic and environmental factors. The genetic effect of diabetes seemed stronger on female than that on male twins but was dying down along with ageing.

From 1999 to 2015, there were 6 186 cases of leukemia deaths in tianjin residents, the males accounted for 58.28% (3 605) and 52.31% (3 236) deaths lived in urban areas; the crude mortality rate of Leukemia increased from 3.47/100 000 to 4.28/100 000 [ t= 7.09, P< 0.001, annual percent change (APC)=1.30%] and the standardized mortality rate decreased from 3.15/100 000 to 3.01/100 000 ( t= -2.95, P= 0.006, APC=-0.65%). Special attention should be focused on children, the elderly, males and rural residents.

Objective: To analyze the mortality and years of life lost (YLL) trends of cervical cancer in Tianjin, and provide references for the research and prevention programs of cervical cancer. Methods: Mortality rate, standard mortality rate, cumulative rate (0-74 years-old) and truncated rate (35-64 years-old) of cervical cancer from 1999 to 2015 were calculated. The annual percentage change of the mortality rate and YLL rate were analyzed by using Joinpoint regression analysis, and the trend in different age-groups were analyzed. Results: From 1999 to 2015, 1 741 cases died of cervical cancer in Tianjin, the average crude mortality rate was 2.15/100 000. The average age-standardized rate of (ASR) China and ASR world were 1.47/100 000 and 1.50/100 000 respectively. The average YLL was 3 347.97 person-years. Deaths occurred in those aged 0-34 years, 35-64 years and 65 years and over accounted for 3.10 % , 57.84 % and 39.06 % of the total, respectively. The mortality rate of cervical cancer in urban area was higher than that in rural area, with a ratio of 1.37∶1 between urban area and rural area. The age-specific mortality rate of cervical cancer during 1999-2015 increased with age. Two peaks of mortality rate were observed in those aged 50 years and aged 75 years, during 2014-2015. From 1999 to 2011, the mortality rate of cervical cancer was stable (APC=-0.2 % , P =0.80), but there was a rapid increase from 2011 to 2015 (APC=21.6 % , P <0.01). But group aged 20-49 years, it showed an upward trend from 1999 to 2015 (APC=6.9 % , P <0.01). For group aged 50-69 years, it showed a downward trend from 1999 to 2007 (APC=-9.2 % , P <0.01), and an upward trend from 2007 to 2015 (APC=14.5 % , P <0.01). For group aged 70 years and over, it showed a downward trend from 1999 to 2009 (APC=-10.2 % , P <0.01), but the difference in the mortality were not significant from 2009 to 2015 (APC=7.8 % , P =0.10). Since 2008, the YLL rate of cervical cancer in group aged 50-70 years had exceeded that in group aged >70 years and the gap gradually widened. Conclusions: There had been a rapid increase trend of cervical cancer mortality since 2011 in Tianjin. Women aged 50-70 years were the main group of life loss.

Objective: To evaluate the behavior intervention program on men who have sex with men (MSM) in Tianjin. Methods: From April 2013 to September 2017, MSM were enrolled from MSM gathering places and through mobile internet to establish an open prospective cohort. Interventions were conducted in every follow-up meeting, while the changes of behaviors and HIV infection and syphilis incidences in the MSM before and after intervention were compared. Results: A total of 1 822 MSM were interviewed at baseline survey, with 1 007 eligible MSM were enrolled in the cohort. A total of 39 new cases of HIV infection were reported, and the cumulative observation time on cohort follow-up was 2 216.96 person-year, with the HIV incidence rate as 1.76 per 100 person-years. Among them, 934 MSM were sero-negative for syphilis in baseline survey. A total of 100 new cases of syphilis were reported, and the cumulative observation time of cohort follow-up was 1 959.94 person-year, the syphilis incidence rate was 5.10 per 100 person-years. With health education and intervention conducted, the awareness rate of AIDS related knowledge for MSM increased. Though the rate of anal sex increased after intervention, the rate of condom use in anal sex increased, too. The rate of condom use decreased after receiving more than 3 interventions. Data from the multivariate GEE analysis indicated that protective factors might be as follows: education level of college and above (a OR =0.81, 95 %CI : 0.68-0.98), awareness of AIDS related knowledge (a OR =0.52, 95 %CI : 0.36-0.75), ever receiving condom promotion and distribution in the past six months (a OR =0.60, 95 %CI : 0.49-0.74), being recruited from mobile internet (a OR =0.85, 95 %CI : 0.73-1.00) and times of cumulative intervention: one time (a OR =0.55, 95 %CI : 0.45-0.66), two times (a OR =0.38, 95 %CI : 0.30-0.49), three times (a OR =0.26, 95 %CI : 0.20-0.35), four times and above (a OR =0.24, 95 %CI : 0.17-0.33). Diagnoses of STDs in the past six months (a OR =1.43, 95 %CI : 1.06-1.96), using rush-poppers (a OR =1.22, 95 %CI : 1.02-1.47) might be risk factors. Conclusions: After continuous behavior intervention, the incidence of HIV infection and syphilis were at a low level in the MSM cohort in Tianjin. Their awareness rate of AIDS related knowledge and the rate of condom use increased. But there are still many risk factors influencing the unprotected anal sex in MSM. We should continuously carry out behavioral intervention programs to prevent unprotected anal sex among MSM.

Objective: To explore the trends and distribution of chronic obstructive pulmonary disease (COPD) mortality of the residents with different characteristics from 2000 to 2016 in Tianjin. Methods: COPD mortality data in 2000-2016 were from Tianjin population based mortality surveillance system. The mortality rate of COPD, difference in the rate by gender, age, and geographic distribution, and the trend over years were analyzed. Age-sex-standardized mortality rates of COPD were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend analysis were used to examine the trend of mortality. Results: The crude COPD mortality rate in Tianjin decreased from 57.57/100 000 in 2000 to 28.23/100 000 in 2016 (annual percent change (APC)=-5.01%, Z=- 64.76, P< 0.001), and the standardized mortality rate decreased from 56.53/100 000 in 2000 to13.88/100 000 in 2016 (APC=-9.17%, Z=- 100.83, P< 0.001). The crude COPD mortality rate of males decreased from 54.57/100 000 to 27.77/100 000 (APC=-4.89%, Z=- 43.63, P< 0.001) and the standardized mortality rate decreased from 57.52/100 000 to 14.63/100 000 (APC=-9.07%, Z=- 71.48, P< 0.001). The crude COPD mortality rate of females decreased from 60.63/100 000 to 28.68/100 000 (APC= - 5.12%, Z=- 47.92, P< 0.001) and the standardized mortality rate decreased from 55.53/100 000 to 13 13/100 000 (APC= - 9.27%, Z=- 71.13, P< 0.001). The crude mortality rate of COPD in urban areas decreased from 45.07/100 000 to 19.54/100 000 (APC= - 5.35%, Z=- 42.38, P< 0.001) and the standardized mortality rate decreased from 39.24/100 000 to 7.45/100 000 ( Z=- 63.97, P< 0.001, APC= - 10.22%). The crude mortality rate of COPD in rural areas decreased from 70.20/100 000 to 37.24/100 000 (APC= - 4.77%, Z=- 48.77, P< 0.001) and the standardized mortality rate decreased from 78.88/100 000 to 25.70/100 000 (APC= - 7.59%, Z=- 72.43, P< 0.001). The COPD mortality rate in rural areas was higher than that in urban areas ( P< 0.001). The COPD mortality rate in 35 years old and over decreased from 2000 to 2016 ( P< 0.001). Conclusion: The COPD mortality in Tianjin decreased from 2000 to 2016. More efforts are need to reduce COPD mortality in Tianjin, in particular people in rural areas.

Objective: To explore the trends and distribution of intracerebral hemorrhage (ICH) mortality of the residents with different characteristics from 1999 to 2015 in Tianjin. Methods: ICH mortality data in 1999-2015 were from Tianjin population based mortality surveillance system. The mortality rate of ICH, difference in the rate by gender, age, and geographic distribution, and trends over the years were analyzed. Standardized mortality rates of ICH were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to examine the trends in mortality. Results: A total of 102 279 ICH death cases were observed in Tianjin from year 1999 to 2015. The crude ICH mortality rate in Tianjin decreased from 76.35/100 000 in 1999 to 51.46/100 000 in 2015 (annual percent change (APC)=-1.96%, Z= -31.08, P< 0.001) , and the standardized mortality rate decreased from 72.41/100 000 to 29.00/100 000 (APC=-5.20%, Z= -70.91, P< 0.001). The crude mortality rate of ICH mortality in males decreased from 87.26/100 000 to 59.89/100 000 (APC=-1.79%, Z= -21.71, P< 0.001) and the standardized mortality rate decreased from 85.65/100 000 to 35.75/100 000 (APC=-4.93%, Z= -52.32, P< 0.001). The crude mortality rate of ICH mortality in females decreased from 65.21/100 000 to 42.98/100 000 (APC=-2.18%, Z= -22.28, P< 0.001) and the standardized mortality rate decreased from 59.17/100 000 to 22.26/100 000 (APC=-5.63%, Z= -48.15, P< 0.001). The ICH mortality rate under 35 years old increased from 0.78/100 000 to 0.92/100 000 (APC=4.41%, Z= 5.07, P< 0.001), especially in males increasing from 0.90/100 000 to 1.54/100 000 (APC=6.59%, Z= 6.52, P< 0.001). The crude mortality rate of ICH in urban areas decreased from 69.74/100 000 to 41.79/100 000 (APC=-3.18%, Z= -31.43, P< 0.001) and the standardized mortality rate decreased from 57.56/100 000 to 20.42/100 000 (APC=-6.59%, Z= -53.43, P< 0.001). The crude mortality rate of ICH in rural areas decreased from 82.99/100 000 to 61.49/100 000 (APC=-1.10%, Z= -14.06, P< 0.001) and the standardized mortality rate decreased from 91.55/100 000 to 43.14/100 000 (APC=-3.78%, Z =-43.21, P< 0.001). The ICH mortality rate in rural areas was higher than that in urban areas ( P< 0.05). Conclusion: ICH mortality rate in Tianjin decreased from 1999 to 2015. Further efforts to reduce ICH mortality in Tianjin is needed, in particular males, under 35 years old, and people in rural areas.

Objective: To explore the trends and distribution of cerebral infarction between sexes, ages and urban-rural areas from 1999 to 2015 in Tianjin, China, and provide data for targeted prevention and control strategies of cerebral infarction in Tianjin. Methods: Cerebral infarction mortality data from January 1, 1999 to December 31, 2015 were obtained from Tianjin population based mortality surveillance system established by the Tianjin Centers for Disease Control and Prevention, and population data of permanent residents were obtained from Tianjin Municipal Public Security Bureau. The trends change and affecting factors including gender, age, and geographic distribution on mortality following cerebral infarction were analyzed. Results: (1) Cerebral infarction mortality rate in Tianjin increased from 1999 to 2015 with the crude mortality rate of 57.06/100 000 to 105.22/100 000 ( Z= 59.65, P< 0.01, annual percent change(APC)=3.39%) and decreased with the standardized mortality rate from 55.59/100 000 to 56.12/100 000 ( Z= -5.47, P< 0.01, APC=-0.35%). (2) The crude mortality rate (64.23/100 000 to 118.72/100 000) and standardized mortality rate (65.44/100 000 to 67.23/100 000) of male cerebral infarction was higher than that of female (crude: 49.73/100 000 to 91.64/1/100 000, standardized: 45.73/100 000 to 45.01/100 000) from 1999 to 2015. (3) With the increase of age, the mortality of cerebral infarction increased gradually from 1999 to 2015 (all Z> 0.00,all P< 0.01). (4) The mortality rate of cerebral infarction in urban areas increased with the crude mortality rate from 71.43/100 000 to 103.20/100 000 ( Z= 17.34, P< 0.01, APC=1.30%) and decreased with the standardized mortality rate from 61.04/100 000 to 43.77/100 000 ( Z= -32.49, P< 0.01, APC=-3.06%) from 1999 to 2015. The mortality rate of cerebral infarction in rural areas increased with the crude mortality rate from 42.63/100 000 to 107.32/100 000 ( Z= 69.14, P< 0.01, APC=5.95%) and with the standardized mortality rate from 48.34/100 000 to 77.09/100 000 ( Z= 36.88, P< 0.01, APC=5.95%) from 1999 to 2015. Conclusions: Cerebral infarction crude mortality increased and standardized mortality decreased from 1999 to 2015 in Tianjin. Further efforts to reduce cerebral infarction mortality in Tianjin are needed, special attention should be focused on the elderly, male and rural residents.