Search

ObjectiveTo explore the relationship between comorbidity and comorbidity pattern prevalence and mobility function among community-dwelling the elderly in Zhejiang province, and to provide a reference basis for the prevention and intervention of comorbidity prevalence in the elderly. MethodsFrom June to December 2022, a multi-stage random sampling method was used to select 7 776 community-dwelling the elderly aged ≥ 60 years old in Zhejiang province for a questionnaire survey. The relationship between comorbidity and comorbidity pattern prevalence and mobility function was analyzed among the 2 445 the elderly who were finally included and participated in the mobility function test. ResultsAmong the 2 445 community-dwelling the elderly in Zhejiang province, 1 250 had comorbidities, with a comorbidity prevalence rate of 51.12%; 533 had cardiovascular-metabolic comorbidity pattern, with a comorbidity prevalence rate of 21.80%; 323 had respiratory system comorbidity pattern, with a comorbidity prevalence rate of 13.20%; 143 had mental-sensory comorbidity pattern, with a comorbidity prevalence rate of 5.84%; and 258 had musculoskeletal joint comorbidity pattern, with a comorbidity prevalence rate of 10.55%. The completion time of the Timed Up and Go (TUG) test for community-dwelling the elderly in Zhejiang province ranged from 5.05 to 59.55 s, with a mean completion time of (11.21 ± 3.15) s; the completion time of the One-Leg Standing with Eyes Closed (OLS-EC) test ranged from 0 to 29 s, with a mean completion time of (3.72 ± 2.72) s; and the number of repetitions completed in the 30-second Chair Stand (CS-30) test ranged from 0 to 30, with a mean number of repetitions of (13.51 ± 3.79). After adjusting for confounding factors such as gender, age, education level, marital status, and place of residence, community-dwelling the elderly with comorbidities in Zhejiang province had longer TUG completion times (β = 0.51, 95%CI: 0.26 – 0.19), and fewer CS-30 repetitions (β = – 0.73, 95%CI: – 1.02 – – 0.45) compared to those without comorbidities; community-dwelling the elderly with cardiovascular-metabolic comorbidity pattern had longer TUG completion times (β = 0.59, 95%CI: 0.30 – 0.23), and fewer CS-30 repetitions (β = – 0.78, 95%CI: – 1.13 – – 0.43) compared to those without cardiovascular-metabolic comorbidities; community-dwelling the elderly with respiratory system comorbidity pattern had fewer CS-30 repetitions (β = – 1.34, 95%CI: – 2.61 – – 0.07) compared to those without respiratory system comorbidities; and community-dwelling the elderly with musculoskeletal joint comorbidity pattern had longer TUG completion times (β = 0.47, 95%CI: 0.08 – 0.02) compared to those without musculoskeletal joint comorbidities. ConclusionThe prevalence of comorbidities among community-dwelling the elderly in Zhejiang province was positively correlated with the risk of individual mobility function decline, and the impact of different comorbidity pattern prevalence on the mobility function of community-dwelling the elderly varies.

ObjectiveTo understand the health utility value and its influencing factors among adult residents in Zhejiang province, and to provide a reference for health policy formulation and evaluation. MethodsA face-to-face survey using a self-developed questionnaire was conducted from September 2022 to February 2023 among 9 000 adult residents (≥ 18 years) recruited using a multistage random sampling technique from 30 districts/counties in Zhejiang province. Participants' health utility values were calculated and adjusted using the compound hierarchical ordered probit model (CHOPIT). Multiple linear regression model and Shapley value decomposition method were used to analyze the effects and contributions of influencing factors on participants' health utility values. ResultsThe mean health utility value was 0.703 ± 0.158 for 8 684 successfully surveyed participants. The Shapley value decomposition analysis showed that the Shapley value was 0.277 for demographic characteristics, 0.106 for socioeconomic status, 0.042 for accessibility of health services, 0.067 for behavioral habits, and 0.024 for health status, with attributable contributions of 53.67%, 20.62%, 8.16%, 12.95%, and 4.60% to the health utility value, respectively. The multiple linear stepwise regression model analysis showed that gender, age, education level, occupation, annual household income per capita, hypertension, and sleep quality were the main factors influencing the health utility value of the adult residents, with Shapley values/attributed contributions of 0.006/0.98%, 0.114/18.01%, 0.188/29.09%, 0.029/4.65%, 0.229/35.84%, 0.020/3.18%, and 0.052/8.25%, respectively, and being female, older age, lower education level, being retired, lower annual household income per capita, hypertension, and poor sleep quality were correlated with reduced health utility value of adult residents. ConclusionThe overall self-rated health of adult residents in Zhejiang province is relatively good. Attention should be paid to the health status of adult residents who are female, middle-aged and elderly, with low education and low household income, as well as those with hypertension and poor sleep quality, in order to further improve the health-related quality of life of residents.

Background There is scant evidence regarding the safety of antiplatelet therapy in acute ischemic stroke (AIS) patients with thrombocytopenia. Our study aims to address this concern by examining AIS patients with thrombocytopenia from a large database in real‐world settings. Methods and Results We included patients with AIS with a platelet count

Green-blue spaces (GBS) are pivotal in mitigating thermal discomfort. However, their management lacks guidelines rooted in epidemiological evidence for specific planning and design. Here we show how various GBS types modify the link between non-optimal temperatures and cardiovascular mortality across different thermal extremes. We merged fine-scale population density and GBS data to create novel GBS exposure index. A case time series approach was employed to analyse temperature-cardiovascular mortality association and the effect modifications of type-specific GBSs across 1085 subdistricts in south-eastern China. Our findings indicate that both green and blue spaces may significantly reduce high-temperature-related cardiovascular mortality risks (e.g., for low (5%) vs. high (95%) level of overall green spaces at 99th vs. minimum mortality temperature (MMT), Ratio of relative risk (RRR) = 1.14 (95% CI: 1.07, 1.21); for overall blue spaces, RRR = 1.20 (95% CI: 1.12, 1.29)), while specific blue space types offer protection against cold temperatures (e.g., for the rivers at 1st vs MMT, RRR = 1.17 (95% CI: 1.07, 1.28)). Notably, forests, parks, nature reserves, street greenery, and lakes are linked with lower heat-related cardiovascular mortality, whereas rivers and coasts mitigate cold-related cardiovascular mortality. Blue spaces provide greater benefits than green spaces. The severity of temperature extremes further amplifies GBS's protective effects. This study enhances our understanding of how type-specific GBS influences health risks associated with non-optimal temperatures, offering valuable insights for integrating GBS into climate adaptation strategies for maximal health benefits.

Background: Research into the pivotal role of potassium in chronic diseases and their comorbidities remains scarce. Our aim is to elucidate the relationship between potassium and chronic diseases, including comorbid conditions, and to provide evidence-based recommendations for potassium intake in patients. Methods: This study is anchored in a representative, population-based survey conducted in Zhejiang Province, China, in 2017, encompassing participants aged 18 to 69 years. Data collection included questionnaire responses, physical measurements, and biological samples, obtained through a multistage cluster random sampling method. A subset of 1496 participants provided complete 24 h urine samples. Results: The median age of the participants was 48.0 years (interquartile range [IQR] 24.0), with 51.1% being female, and hypertension was identified in more than one third (35.6%) of the participants. The prevalence of diabetes was approximately 9.0%, dyslipidemia was found in 34.2%, and microalbuminuria in 8.8%. The 24 h urinary excretion levels were 3613.3 mg/24 h (IQR 2161.7) for sodium and 1366.0 mg/24 h (IQR 824.9) for potassium, respectively. Potassium excretion exhibited an inverse relationship with blood pressure. Furthermore, a positive correlation was observed between potassium excretion and high-density lipoprotein cholesterol (HDL-C) levels, with an elevation of 0.03 mmol/L (95% confidence interval [CI] 0.00 to 0.05). In binary logistic regression analysis, individuals in the fourth quartile of potassium excretion (Q4) exhibited an odds ratio (OR) of 0.56 (95% CI 0.36–0.87) for hypertension compared to those in the first quartile (Q1). Urinary potassium excretion was inversely associated with low HDL-C levels, with Q4 individuals having 0.62 times the odds of having low HDL-C levels (OR, 0.62; 95% CI 0.39–1.00) compared to Q1. Conclusions: Potassium excretion demonstrated a direct negative correlation with certain comorbidities. This study underscores the pivotal role of potassium in the management of chronic diseases and associated comorbidities, thereby highlighting the significance of potassium in both public health initiatives and clinical practice.

BackgroundExisting literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory. ObjectiveThis study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China. MethodsA total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms. ResultsAmong the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P

Objective: This study describes the association between taste preference for salt and actual salt intake, thus guiding and refining personal and public health campaigns designed to lower salt intake in China. Methods: A cross-sectional survey of 1489 residents aged 18 to 69 years was conducted in 2017 in China. A multistage random sampling strategy was used, and a combination of questionnaires and physical and laboratory measurements were conducted to collect baseline characteristics and knowledge, attitudes, and behavior (KAB) related to salt. A 24 h urine collection was obtained for sodium and potassium excretion analysis. Participants were divided into two groups, light taste preference and salty taste preference, according to their answer to the question “Compared to others, how do you think your taste preference is for salt?”. Results: The mean age of the 1489 participants was 46.26 years, 48.9% were males, over 1/3 (35.7%) were identified as hypertensive, and 317 (21.3%) self-reported a salty taste preference. The mean of 24 h urinary sodium excretion was 167.32 mmol/24 h, corresponding to 9.79 g salt/d intake, and the sodium-to-potassium ratio (Na/K) was 4.90. The 24 h urinary sodium excretion of salty taste preference (177.06 mmol/24 h) was significantly higher than that of light taste preference (164.69 mmol/24 h). The multiple logistic regression analysis showed that the salty taste preference group had significantly higher 24 h urinary sodium (ORa(95%CI) = 1.004(1.002–1.006)), diastolic blood pressure (DBP), proportion of greasy food preference, and drinking levels, but lower potassium excretion, response levels to most KAB questions, and regular physical activity compared to the light taste preference group. Conclusion: Self-reported taste preference for salt predicted actual salt intake, which was verified by 24 h urinary sodium monitoring. Taste preference for salt could be used as a proxy for intake in terms of targeted salt intake, nutrition, and health education.

ObjectiveTo explore the association between the detection of chronic obstructive pulmonary disease (COPD) and occupational hazards exposure among permanent residents ≥ 40 years old in Zhejiang province for providing evidence to COPD prevention. MethodsFace-to-face questionnaire interview, anthropometry measurement and pulmonary function test were conducted among 3 004 permanent urban/rural residents aged 40 years and above recruited with stratified multistage random sampling in five counties/prefectures of Zhejiang province during April – December 2019. Unconditional multivariate logistic regression model was applied to analyze the correlation between occupational hazards exposure and the detection of COPD. Results Among the 2 926 participants (51.3% males, 48.7% females) finally included in the analysis, 1 004 (34.3%) and 755 (25.8%) reported having been exposed to occupational dust and harmful gas; the percentages of the participants reporting specific occupational history were 1.6% (48 participants) for coal/mining/quarrying/gas industry, 1.8% (53) for metallurgy/casting/machine manufacturing industry, 3.2% (95) for cement/asbestos/ceramics/glass/graphite produc-tion, 4.1% (119) for engineering/construction engineering/traffic construction, 3.7% (108) for petrochemical/chemical/pharma-ceutical industry, 5.4% (157) for wood processing/furniture processing/house decoration industry, 3.4% (100) for textile/papermaking/cotton/fur processing, 2.2% (63) for dry cleaning/cleaning/cook/porter work, and 18.8% (551) for farm work, respectively. Totally 361 (12.34%) participants were detected as having COPD based on the results of pulmonary function test (forced expiratory volume in one second [FEV1]/forced vital capacity [FVC] < 70%). The results of logistic regression analysis revealed that the participants with farm work history were more likely to have COPD (odds ratio = 1.38, 95% confidence interval: 1.05 − 1.89) after adjusting for sex, age, education, marital status, body mass index and smoking status. ConclusionBeing engaged in farm work may be a risk factor for COPD among residents 40 years old and above in Zhejiang province.

Objectives To ascertain the prevalence and associated factors of anxiety symptoms among middle and high school students in Zhejiang after 2 years of the COVID-19 pandemic.Design A school-based cross-sectional study.Setting 30 counties/districts in Zhejiang Province, China.Participants 27 019 students attending middle and high schools.Outcome measures Anxiety symptoms were assessed using the Generalised Anxiety Disorder 7-item scale (GAD-7). A total score of 10 or more is considered indicative of anxiety symptoms.Results The overall prevalence (95% CI) of anxiety symptoms was 14.2% (13.4 to 15.0), higher among girls (18.6%, 95% CI: 17.5 to 19.7) than boys (10.2%, 95% CI: 9.5 to 10.9) (p

Abstract To assess the relationship of sodium, potassium and the ratio of sodium to potassium (Na/K) with albuminuria, a cross-sectional study was carried out in China in 2017. Sodium, potassium and albumin excretions were examined in a 24-h (h) urine sample collected from 1486 participants. Microalbuminuria was defined as 24-h urinary albumin excretion between 30 and 300 mg/24 h. The participants had an average age of 46.2 ± 14.1 years old, and 48.9% were men. The proportion of patients with microalbuminuria was 9.0%. As illustrated by the adjusted generalized linear mixed model, sodium concentration increased significantly with the increase in 24-h urinary albumin (β = 1.16, 95% confidence interval (CI) 0.38–1.93; P = 0.003). Multivariable-adjusted logistic regression analyses demonstrated that the odds ratio (OR) of microalbuminuria increased with the quartiles of sodium [OR = 2.20, 95% CI 1.26–3.84 (the maximum quartile vs. the minimum quartile), P for trend = 0.006]. Potassium and the Na/K ratio did not have any association with outcome indicators. A high amount of sodium intake was potentially correlated with early renal function impairment.

Injury poses heavy burden on public health, but little evidence on the potential role of climate change on injury exists. Here, the authors collect data during 2013-2019 in six provinces of China to estimate the associations between temperature and injury mortality, and to project future mortality burden attributable to temperature change driven by climate change.

Abstract To understand the association between sodium and potassium consumption levels, hypertension and knowledge, attitudes and behaviors (KAB) toward salt and the commitment to effective sodium reduction and potassium supplementation to achieve the purpose of suppressing hypertension. A stratified multistage random sampling method was used to obtain a representative provincial sample of 7512 residents aged 18–69 years through a cross-sectional survey by the Salt Reduction and Hypertension Prevention Project (SRHPP) in Zhejiang Province of China in 2017–2018. A screening including demographic, anthropometric, salt-related KAB and physical measurements was implemented, and 24-h urine of approximately 1/5 of the participants was collected and tested. The mean age was 44.8 years, 50.1% were women, 44.0% lived in urban areas, and hypertension or prehypertension accounted for approximately 35.0%. The mean 24-h urinary sodium and potassium excretion were 3848.5 (1661.1) mg/d and 1491.1 (710.9) mg/d, respectively. KAB in urban areas was generally more favorable than in rural areas, women were better than men, and the optimal blood pressure group was better than the other two groups (P

BackgroundDrowning is a serious public health problem worldwide. Previous epidemiological studies on the association between meteorological factors and drowning mainly focused on individual weather factors, and the combined effect of mixed exposure to multiple meteorological factors on drowning is unclear. ObjectiveWe aimed to investigate the combined effects of multiple meteorological factors on unintentional drowning mortality in China and to identify the important meteorological factors contributing to drowning mortality. MethodsUnintentional drowning death data (based on International Classification of Diseases, 10th Edition, codes W65-74) from January 1, 2013, to December 31, 2018, were collected from the Disease Surveillance Points System for Guangdong, Hunan, Zhejiang, Yunnan, and Jilin Provinces, China. Daily meteorological data, including daily mean temperature, relative humidity, sunlight duration, and rainfall in the same period were obtained from the Chinese Academy of Meteorological Science Data Center. We constructed a time-stratified case-crossover design and applied a generalized additive model to examine the effect of individual weather factors on drowning mortality, and then used quantile g-computation to estimate the joint effect of the mixed exposure to meteorological factors. ResultsA total of 46,179 drowning deaths were reported in the 5 provinces in China from 2013 to 2018. In an effect analysis of individual exposure, we observed a positive effect for sunlight duration, a negative effect for relative humidity, and U-shaped associations for temperature and rainfall with drowning mortality. In a joint effect analysis of the above 4 meteorological factors, a 2.99% (95% CI 0.26%-5.80%) increase in drowning mortality was observed per quartile rise in exposure mixture. For the total population, sunlight duration was the most important weather factor for drowning mortality, with a 93.1% positive contribution to the overall effects, while rainfall was mainly a negative factor for drowning deaths (90.5%) and temperature and relative humidity contributed 6.9% and –9.5% to the overall effects, respectively. ConclusionsThis study found that mixed exposure to temperature, relative humidity, sunlight duration, and rainfall was positively associated with drowning mortality and that sunlight duration, rather than temperature, may be the most important meteorological factor for drowning mortality. These findings imply that it is necessary to incorporate sunshine hours and temperature into early warning systems for drowning prevention in the future.

BackgroundGrowing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China.MethodsWe conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults.ResultsIn total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55–2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42–2.42) and 3.45 (95% CI: 1.47–6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30–1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04–2.38).ConclusionThe association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.

BackgroundExisting literature on the association of electronic screen use duration with depression among adolescents is contradictory. The current study aimed to elucidate the association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students in Zhejiang Province, China.MethodsA cross-sectional study of 27,070 students in grades 7–12 from 376 middle and high schools was conducted through an anonymous self-administered questionnaire between April and June 2022. Poisson regression was utilized to examine the association between electronic screen use duration for non-educational purposes and depression symptoms.ResultsOf the 27,006 eligible students, 51.6% (13932) were boys and the mean (SD) age was 15.6(1.7) years. The overall prevalence of symptoms of depression was 22.4% (95%CI 21.4–23.4); girls (27.6%, 26.2–29.0) had a higher prevalence than boys (17.7%, 16.7–18.8). After adjustment for socio-demographic status, lifestyle factors, self-perceived health, academic performance, loneliness and sadness, compared to those who did not use electronic screens for non-educational purposes, the prevalence ratios (PRs) for depression symptoms were 1.03 (95% CI 1.02–1.04) for those exposed to electronic screens for

Properly analyzing and reporting data remains a challenging task in epidemiologic research, as underreporting of data is often overlooked. The evaluation on the effect of underreporting remains understudied. In this study, we examined the effect of different scenarios of mortality underreporting on the relationship between PM10, temperature, and mortality. Mortality data, PM10, and temperature data in seven cities were obtained from Provincial Center for Disease Control and Prevention (CDC), China Meteorological Data Sharing Service System, and China National Environmental Monitoring Center, respectively. A time-series design with a distributed lag nonlinear model (DLNM) was used to examine the effects of five mortality underreporting scenarios: 1) Random underreporting of mortality; 2) Underreporting is monotonically increasing (MI) or monotonically decreasing (MD); 3) Underreporting due to holiday and weekends; 4) Underreporting occurs before the 20th day of each month, and these underreporting will be added after the 20th day of the month; and 5) Underreporting due to holiday, weekends, MI, and MD. We observed that underreporting at random (UAR) scenario had little effect on the association between PM10, temperature, and daily mortality. However, other four underreporting not at random (UNAR) scenarios mentioned above had varying degrees of influence on the association between PM10, temperature, and daily mortality. Additionally, in addition to imputation under UAR, the variation of minimum mortality temperature (MMT) and attributable fraction (AF) of mortality attributed to temperature in the same imputation scenarios is inconsistent in different cities. Finally, we observed that the pooled excess risk (ER) below MMT was negatively associated with mortality and the pooled ER above MMT was positively associated with mortality. This study showed that UNAR impacted the association between PM10, temperature, and mortality, and potential underreporting should be dealt with before analyzing data to avoid drawing invalid conclusions.

Abstract The direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05–1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08–0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (− 3.07 mm Hg; 95% CI − 4.57 to − 1.57) and diastolic BP (− 0.94 mm Hg; 95% CI − 1.87 to − 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42–1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10–0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35–0.84) for potassium and 1.71 (95% CI 1.16–2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83–1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.

Objective To investigate the proportion of willingness for community-based and institutional care and their correlating factors among older adults in Zhejiang Province, China.Design Cross-sectional study.Setting The Sixth National Health Service Survey, carried out in Zhejiang, China.Participants 7300 eligible older adults aged 60 years or older.Main outcomes measures Willingness for community-based and institutional eldercare.Results The average age of the participants was 69.0±7.3 years. 50.9% of the participants were males, and 49.1% were females. 19.2% came from urban areas and 80.8% were from rural areas. The percentage of willingness for community-based and institutional eldercare was 2.7% and 3.8%, respectively. The corresponding figures for females were 2.9% and 3.5%, respectively, and for males were 2.5% and 4.1%, respectively. Factors positively associated with willingness for community-based eldercare included living in urban areas, high educational attainment, more frequent active exercise and living alone. Factors positively associated with willingness for institutional eldercare included age, living at urban areas, high education attainment, more frequent active exercise and receiving assistance with daily living.Conclusions Family eldercare was the priority for older adults compared with community-based and institutional eldercare in Zhejiang. The willingness for community-based and institutional eldercare among older adults was affected not only by the older adults themselves, but also by community and family members.

Background: In an effort to provide greater financial protection from the risk of large medical expenditures, China has gradually added catastrophic medical insurance (CMI) to the various basic insurance schemes. Tongxiang, a rural county in Zhejiang province, China, has had CMI since 2000 for their employee insurance scheme, and since 2014 for their resident insurance scheme.Methods: Compiling and analysing patient-level panel data over five years, we use a difference-in-difference approach to study the effect of the 2014 introduction of CMI for resident insurance beneficiaries in Tongxiang. In our study design, resident insurance beneficiaries are the treatment group, while employee insurance beneficiaries are the control group.Findings: We find that availability of CMI significantly increases medical expenditures among resident insurance beneficiaries, including for both inpatient and outpatient spending. Despite the greater financial protection, out-of-pocket expenditures increased, in part because patients accessed treatment more often at higher-level hospitals.Interpretation: Better financial coverage for catastrophic medical expenditures led to greater access and expenditures, not only for inpatient admissions—the category that most often leads to catastrophic expenditures—but for outpatient visits as well. These patterns of expenditure change with CMI may reflect both enhanced access to a patient's preferred site of care as well as the influence of incentives encouraging more care under fee-for-service payment.Funding: Stanford University's Freeman Spogli Institute for International Studies’ Policy Implementation Lab and a Shorenstein Asia Pacific Research Center faculty research award provided funding for this project.Chinese translation of the abstract (Appendix 1)

BackgroundPrimary prevention of cardiovascular disease (CVD) requires adequate control of hypertension and diabetes. We designed and implemented pharmaceutical and healthy lifestyle interventions for patients with diabetes and/or hypertension in rural primary care, and assessed their effectiveness at reducing severe CVD events.Methods and findingsWe used a pragmatic, parallel group, 2-arm, controlled, superiority, cluster trial design. We randomised 67 township hospitals in Zhejiang Province, China, to intervention (34) or control (33). A total of 31,326 participants were recruited, with 15,380 in the intervention arm and 15,946 in the control arm. Participants had no known CVD and were either patients with hypertension and a 10-year CVD risk of 20% or higher, or patients with type 2 diabetes regardless of their CVD risk. The intervention included prescription of a standardised package of medicines, individual advice on lifestyle change, and adherence support. Control was usual hypertension and diabetes care. In both arms, as usual in China, most outpatient drug costs were out of pocket. The primary outcome was severe CVD events, including coronary heart disease and stroke, during 36 months of follow-up, as recorded by the CVD surveillance system. The study was implemented between December 2013 and May 2017. A total of 13,385 (87%) and 14,745 (92%) participated in the intervention and control arms, respectively. Their mean age was 64 years, 51% were women, and 90% were farmers. Of all participants, 64% were diagnosed with hypertension with or without diabetes, and 36% were diagnosed with diabetes only. All township hospitals and participants completed the 36-month follow-up. At 36 months, there were 762 and 874 severe CVD events in the intervention and control arms, respectively, yielding a non-significant effect on CVD incidence rate (1.92 and 2.01 per 100 person-years, respectively; crude incidence rate ratio = 0.90 [95% CI: 0.74, 1.08; P = 0.259]). We observed significant, but small, differences in the change from baseline to follow-up for systolic blood pressure (-1.44 mm Hg [95% CI: -2.26, -0.62; P < 0.001]) and diastolic blood pressure (-1.29 mm Hg [95% CI: -1.77, -0.80; P < 0.001]) in the intervention arm compared to the control arm. Self-reported adherence to recommended medicines was significantly higher in the intervention arm compared with the control arm at 36 months. No safety concerns were identified. Main study limitations include all participants being informed about their high CVD risk at baseline, non-blinding of participants, and the relatively short follow-up period available for judging potential changes in rates of CVD events.ConclusionsThe comprehensive package of pharmaceutical and healthy lifestyle interventions did not reduce severe CVD events over 36 months. Improving health system factors such as universal coverage for the cost of essential medicines is required for successful risk-based CVD prevention programmes.Trial registrationISRCTN registry ISRCTN58988083.

Abstract Aims/Introduction An elevated heart rate has been reported to be associated with an increased incidence of type 2 diabetes mellitus. We investigated whether heart rate independently and interactively with body mass index or blood pressure was associated with the incidence of type 2 diabetes mellitus in a rural Chinese population. Materials and Methods We measured the association between heart rate and type 2 diabetes mellitus in the Tongxiang China Kadoorie Biobank prospective cohort study using Cox proportional hazard models. Analyses included 53,817 participants without any history of diabetes, cancer, cardiovascular or rheumatic heart disease at baseline. Incident type 2 diabetes mellitus cases were identified through linkage with established Disease Registries and the China National Health Insurance System. Results After a mean follow‐up period of 6.9 years, 1,766 people had developed type 2 diabetes mellitus with an incidence of 4.75 per 1,000 person‐years. Multivariable‐adjusted hazard ratios and for type 2 diabetes mellitus across increasing quintiles of heart rate were 1.00 (reference), 1.24 (95% confidence interval [CI] 1.05–1.45), 1.21 (95% CI 1.03–1.41), 1.24 (95% CI 1.05–1.47) and 1.49 (95% CI 1.28–1.74), respectively, with a Ptrend

Abstract Aims/Introduction To evaluate the annual direct medical cost attributable to type 2 diabetes mellitus according to socioeconomic factors, medical conditions and complications categories. Materials and Methods We created uniquely detailed data from merging datasets of the local diabetes management system and the social security system in Tongxiang, China. We calculated the type 2 diabetes mellitus‐related total cost and out‐of‐pocket cost for inpatient admissions and outpatient visits, and compared the cost for patients with or without complications by different healthcare items. Results A total of 16,675 patients were eligible for analysis. The type 2 diabetes mellitus‐related cost accounted for 40.6% of the overall cost. The cost per patient was estimated to be a median of 1,067 Chinese Yuan, 7,114 Chinese Yuan and 969 Chinese Yuan for inpatient and outpatient cost, respectively. The median total cost for hospital‐based care was 3.69‐fold higher than that for primary care. The median cost of patients with complications was 3.46‐fold higher than that of those without complications. The median cost for a patient with only macrovascular, only microvascular or both macrovascular and microvascular complications were 3.13‐, 3.79‐ and 10.95‐fold higher than that of patients without complications. Pharmaceutical expenditure accounted for 51.8 and 79.7% of the total cost for patients with or without complications, respectively. Conclusions Although the type 2 diabetes mellitus‐related cost per patient was relatively low, it accounted for a great proportion of the overall cost. Complications obviously aggravated the economic burden of type 2 diabetes mellitus. Proper management and the prevention of diabetes and its complications are urgently required to curtail the economic burden.

Abstract Background Suicide is the second leading cause of death among 15–29 year old youths globally, and the third most common external cause of death in China. School bullying can cause serious consequences among adolescents, including psychosocial problems, low self-esteem and post-traumatic stress disorder. Most studies examining the associations between being bullied in school and suicide are from Western, developed countries. Moreover, few studies focus on being threatened or injured with a weapon, which may cause serious body injury. Our study aimed to explore the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among middle and high school students in Zhejiang Province, China. Methods A cross-sectional study of 23,543 students in grades 7–12 from 442 schools was carried out through an anonymous self-administered questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt. Results 51.3% of participants were boys, and mean (SD) age was 15.6 (1.7) years. The overall prevalence of suicidal ideation and attempt were 16.1% (95%CI: 15.3–16.9) and 3.6% (95%CI: 3.3–4.0), respectively. Prevalence was higher among girls than boys (ideation: 19.1% vs. 13.3%. attempt: 4.4% vs. 2.9%). 13.2% of students reported being threatened or injured with a weapon in school in the past 12 months (95%CI: 11.9–14.5), higher among boys than girls (15.7% vs. 10.5%), and among rural students than urban students (13.9% vs. 11.6%). After adjustment for socio-demographic status, lifestyle factors, academic performance, self-reported health and mental health, the odds ratios for suicidal ideation and attempt among students who reported being threatened or injured with a weapon were 1.46 (1.31–1.61) and 1.68 (1.31–2.13) respectively, as compared with those who did not report being threatened or injured. Conclusions Preventive measures for physical bullying in school need to be reinforced in China. Being threatened or injured with a weapon is associated with both suicidal ideation and attempt among middle and high school students. Suicide prevention should be an important component of psychological interventions for threatened or injured students.

Background: Limited evidence is available on the health effects of particulate matter with an aerodynamic diameter of

Abstract Background Obesity has been identified as a major risk factor for a large number of chronic diseases. Understanding factors related to adolescent obesity is critical for prevention of chronic diseases. The associations between sleep duration and obesity among adolescents in the existing literature are controversial. Our study was designed to determine the prevalence of short sleep duration, and assess the association of sleep duration and obesity, among middle and high school students in Zhejiang, China. Methods 18,403 Students in 442 schools were recruited and surveyed using an anonymous, self-administered questionnaires. Weighted multivariable logistic regression models were used for data analyses. Results The mean (SD) age of the students was 15.9 (1.8) years. 49.7% of students were girls. The mean (SD) height and weight were 166.2 (8.5) cm and 54.6 (11.1) kg, respectively. The overall prevalence of obesity and overweight were 3.4% (95% CI: 3.0–3.8) and 7.8% (95% CI: 7.4–8.3), respectively. The overall prevalence of short sleep duration among students was 66.0% (95% CI: 63.8–68.1), higher among girls than boys (69.8% vs. 62.1%) (P

BackgroundIn recent decades, hypertension has become a popular public health problem in China. In 2017, a cross-sectional survey about hypertension and sodium intake measured by 24-hour (24-h) urine was launched in Zhejiang Province, to provide the basis of the Chinese population to develop a salt reduction intervention and prevention of hypertension strategy.MethodsCross-sectional data were obtained from 7512 participants aged 18 to 69 years in Zhejiang Province of China by complex, multistage sampling methods. The survey included face-to-face questionnaires and physical examination among all participants. Blood pressures and the use of anti-hypertension medications were used to determine hypertension. One thousand five hundred participants of them were asked to collect 24-h urine to measure sodium and potassium levels to assess intake. All rates and means were weighted by sampling weight and population structure of the province.ResultsThe weighted means of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 127.78 mm Hg (95% confidence interval [CI], 127.21-128.36) and 79.40 mm Hg (95%CI, 79.04-79.76). The weighted hypertension prevalence was 30.41% (95%CI, 28.91-31.91). Among those classified as having hypertension, 43.55% (95%CI, 40.77-46.34) were aware of the fact that they were suffering from hypertension, 32.05% (95%CI, 29.49-34.61) of them reported taking anti-hypertension medications, only 14.48% (95%CI, 12.54-16.42) had their blood pressure controlled. The weighted means of 24-h urinary sodium was 165.52 mmol (standard deviation [SD], 2.92), representing that the mean intake of sodium chloride was 9.68g (SD, 0.17) through conversion.ConclusionThese cross-sectional survey results show that hypertension and excessive sodium intake in adults are prevalent in Zhejiang Province, China. Salt reduction and prevention of hypertension is still an urgent public health work.

In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China’s Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.

Background: Currently, the studies on the relationship between type 2 diabetes and platelets indicators were carried out on a selective small sample population generally. Large sample studies in this area are rare, especially in Chinese population. In this study, we aimed to investigate the relationship between type 2 diabetes and the mean platelet volume (MPV), platelet count (PLT) and platelet distribution width (PDW). Methods: This is a cross-sectional analysis of the routine health examination data from 20128 participants with complete baseline data in Yinzhou District 2013. The detection of indicators in this study was completed by automatic hematology analyzer. Results: The PDW and PLT were not significantly different between diabetic group and non-diabetic group, (16.00% vs. 16.00%, P=0.88, and 194*109/L vs. 196*109/L, P=0.05 respectively). The MPV was significantly higher in diabetic group (9.3fl vs. 9.2fl, P

This study aims to assess whether a standard intervention package of cardiovascular disease (CVD) care was being delivered effectively, and if it was associated with improved lifestyle and biomedical indicators.In rural China, we implemented a pragmatic cluster randomized controlled trial for 12 months, randomized at the township hospital level, and compared with usual care. Intervention case management guideline, training and performance monitoring meeting and patient support activities were designed to fit within the job description of family doctors in the township hospitals and comprised: 1) prescription of a standardised package of medicines targeted at those with hypertension or diabetes; 2) advice about specific lifestyle interventions; and 3) advice about medication adherence. Participants were 50-74 years old, had hypertension and CVD risk scores >20% or diabetes, but were excluded if a history of severe CVD events. We also randomly selected 100 participants from six selected clusters per arm as a panel to collect intermediate biomedical indicators over time.A total of 28,130 participants, in 33 intervention and 34 control township hospitals, were recruited. Compared with the control arm, participants in the intervention arm had substantially improved prescribing rates of anti-hypertensives, statins and aspirin (P0.05).Implementation of the package by family doctors was feasible and improved prescribing and some lifestyle changes. Additional measures such as reducing medication costs and patient education are required.Current Controlled Trials ISRCTN58988083.

Objective. This study aimed to explore the incidence of stroke and stroke subtypes among patients with type 2 diabetes mellitus (T2DM) based on the long-term surveillance data in Zhejiang, China, during 2007 to 2013. Materials and Methods. During January 1, 2007, and December 31, 2013, a total of 327,268 T2DM and 307,984 stroke patients were registered on Diabetes and Stroke Surveillance System, respectively. Stroke subtypes were classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. The incidence of stroke and stroke subtypes was calculated by standardized incidence ratio (SIRs) with 95% confidence intervals (CIs) compared with general population. Results. The incidence of stroke and stroke subtypes among patients with T2DM was significantly higher than in general population. Stroke risk was found significantly increased with an SIR of 3.87 (95% CI 3.76–3.99) and 3.38 (95% CI 3.27–3.48) in females and males, respectively. The excess risk of stroke was mainly attributable to the significantly higher risk of cerebral infarctions with the risk for T2DM being four times that for general population. Conclusions. The relationship between stroke and T2DM was strong, especially in female. The incidence of stroke and stroke subtypes among patients with T2DM was up to 3-fold higher than in general population in Zhejiang province, especially the subtype of cerebral infarctions.

BACKGROUND: Studies on mental health status of Chinese internal migrants are sparse albeit desperately needed. Deliberate self-harm (DSH) is intimately related to mental disorders, especially depression based on literatures. The major aim of this study is to explore associated factors of severe DSH among Chinese internal migrants. METHODS: Totally 426 DSH migrants identified by a provincial injury sentinel surveillance system between the year 2005 and 2010 were analyzed. Descriptive statistics were used to depict general characteristics of those cases. Chi-square test was used to explore inter-stratum distributive differences of self-harm severity by multiple factors. Logistic regression model was employed to estimate associations between severe self-harm and factors of interest. RESULTS: Among all identified DSH migrants, females took the majority (66.2%), younger individuals accounted for nearly two-thirds of all study subjects. Based on logistic regression model fitting result, age and preceding alcohol drinking were significantly related to self-harm severity, whereas residence place and self-harm method only showed associations with severe DSH in females. CONCLUSIONS: Among Chinese internal migrants, older ones and females who reside in county areas could be more vulnerable to severe self-harm, population-based studies which focusing on the characteristics and risk factors of mental health well-being among Chinese internal migrants are urgently warranted.

Rationale: Evidence for the association between fine particulate matter (PM2.5) and mortality among patients with tuberculosis (TB) is limited. Whether greenness protects air pollution-related mortality among patients with multidrug-resistant tuberculosis (MDR-TB) is completely unknown.Methods: 2305 patients reported in Zhejiang and Ningxia were followed up from MDR-TB diagnosis until death, loss to follow-up or end of the study (31 December 2019), with an average follow-up of 1724 days per patient. 16-day averages of contemporaneous Normalised Difference Vegetation Index (NDVI) in the 500 m buffer of patient's residence, annual average PM2.5 and estimated oxidant capacity Ox were assigned to patients regarding their geocoded home addresses. Cox proportional hazards regression models were used to estimate HRs per 10 μg/m3 exposure to PM2.5 and all-cause mortality among the cohort and individuals across the three tertiles, adjusting for potential covariates.Results: HRs of 1.702 (95% CI 1.680 to 1.725) and 1.169 (1.162 to 1.175) were observed for PM2.5 associated with mortality for the full cohort and individuals with the greatest tertile of NDVI. Exposures to PM2.5 were stronger in association with mortality for younger patients (HR 2.434 (2.432 to 2.435)), female (2.209 (1.874 to 2.845)), patients in rural (1.780 (1.731 to 1.829)) and from Ningxia (1.221 (1.078 to 1.385)). Cumulative exposures increased the HRs of PM2.5-related mortality, while greater greenness flattened the risk with HRs reduced in 0.188-0.194 on average.Conclusions: Individuals with MDR-TB could benefit from greenness by having attenuated associations between PM2.5 and mortality. Improving greener space and air quality may contribute to lower the risk of mortality from TB/MDR-TB and other diseases. [ABSTRACT FROM AUTHOR]