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Asthma mortality among children and adolescents at the national level in China was unreported. The aim of this study was to analyze the mortality of asthma among children and adolescents in China using a nationally representative database.This was a descriptive study using data from the Disease Surveillance Points (DSPs) system. All asthma-related deaths among children and adolescents aged 0-19 years occurring in DSPs across China from 2008 to 2018 were included. Multilevel Poisson regression models were used to compute the total, age-, gender-, region- and residence-specific asthma mortality rates and to investigate the significance of trends and factors associated with asthma mortality. Data from the National Bureau of Statistics were used to estimate the national asthma deaths.Total asthma mortality rate among Chinese children and adolescents fluctuated between 0.020 (0.009, 0.045) and 0.059 (0.025, 0.137) per 100,000 and showed an overall downward trend (RR, 0.909; 95% CI 0.854-0.968) during the study period (2008-2018). Asthma mortality rate was higher in the western China (RR 2.356, 95% CI 1.513, 3.669) and varied over a ninefold range among DSPs in China. The estimated number of deaths decreased by 51.38% from 2008 (n = 148; 95% CI 58,379) to 2018 (n = 71; 95% CI 34, 109).Asthma mortality rate among children and adolescents in China was at a low level compared to rates worldwide and decreased significantly from 2008 to 2018. Compared with most countries in the world, the number of asthma deaths was higher in China.

We aimed to investigate and interpret the associations between socioeconomic factors and the prevalence, awareness, treatment, and control of hypertension at the provincial level in China.A nationally and provincially representative sample of 179,059 adults from the China Chronic Disease and Nutrition Surveillance study in 2015-2016 was used to estimate hypertension burden. The spatial Durbin error model was fitted to investigate socioeconomic factors associated with hypertension indicators.Overall, it was estimated that 29.20% of the participants were hypertensive nationwide, among whom, 34.32% were aware of their condition, 27.69% had received antihypertensive treatment, and 7.81% had controlled their condition. Per capita gross domestic product (GDP) was associated with hypertension prevalence (coefficient: -2.95, 95%Hypertension indicators were not only directly influenced by socioeconomic factors of local area but also indirectly affected by characteristics of geographical neighbors. Population-level strategies should involve optimizing supportive socioeconomic environment by integrating clinical care and public health services to decrease hypertension burden.

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

A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies. Retrospective analysis of multiple cause of death (MCOD) recorded in the population-based national mortality surveillance system (NMSS) of China. All sepsis-related deaths occurring in 605 disease surveillance points (DSPs) covering 323.8 million population across China were included in our study. Age-standardized mortality and national estimate of sepsis-related deaths were estimated using the census population in 2010 and 2015, respectively. In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and standardized sepsis-related mortality rate was 66.7 (95% confidence interval [CI] 66.4–67.0) deaths per 100,000 population. This produced a national estimate of 1,025,997 sepsis-related deaths. Sepsis-related mortality rates exhibited significant geographic variation. In multilevel analysis, male sex (rate ratio [RR] 1.582, 95% CI 1.570–1.595), increasing age (RR 1.914 for 5-year group, 95% CI 1.910–1.917), and presence of comorbidity (RR 2.316, 95% CI 2.298–2.335) were independently associated with increased sepsis-related mortality. Higher disposable income (RR 0.717 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.515–0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.684–0.955) were negatively associated with sepsis-related mortality. However, population-based hospital doctors were not significantly associated with sepsis-related mortality. The standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices, even though some uncertainty remained.

This study examined vegetable and fruit (VF) consumption rate and its associated factors among Chinese adults.Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors (e.g., meal frequency and physical activity) were examined through logistic regression analysis.The average fruit consumption was 102.3 g/day (95% CI: 97.0-107.6) and the average vegetable consumption was 350.6 g/day (95% CI: 339.3-361.8). Over half (53.2%, 95% CI: 50.9-55.4) of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization (WHO). Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% (95% CI: 46.2%-52.2%) vs. 44.0% (95% CI: 41.7%-46.3%) P0.01]. Old age (OR = 1.01, 95% CI: 1.00-1.01), low educational level, low income, minority ethnicity (OR = 1.41, 95% CI: 1.15-1.74), underweight (OR = 1.17, 95% CI: 1.03-1.33), single marital status (OR = 1.20, 95% CI: 1.08-1.33), low health literacy, irregular breakfast (OR = 1.20, 95% CI: 1.04-1.38) or lunch (OR = 1.58, 95% CI: 1.26-1.99) habits, and no leisure-time physical activity were associated with low VF consumption.Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.

To analyze the prevalence and years lived with disability (YLD) from dental caries among children and adolescents and the time trends over the past two decades in Sichuan province, the largest province in west China.Based on the Global Burden of Disease Study 2015 (GBD2015), which systematically assessed the epidemiological characteristics of major diseases and their transitions by country and region from 1990 to 2015, we extracted the estimated results for China. We then used the Bayesian meta-regression method to estimate the sex- and age-specific prevalences and YLDs from dental caries among children and adolescents under 15 years old in Sichuan province and compared them with global and national indicators for the same period.In 2015, there were almost 6 million cases of dental caries in children and adolescents (aged15 years) in Sichuan province, accounting for 6% of the total cases in China. For children under 5 years, the prevalence of deciduous caries was 55.9%, and the YLDs value was 10.8 per 100,000, while it was 24.3% and 5.1 per 100,000 respectively among 5- to 14-year-olds; for those aged 5 to 14 years, the prevalence of permanent caries was 21.5%, and the YLDs value was 11.5 per 100,000. From 1990 to 2015, the prevalence of dental caries for children under 5 years increased substantially, by 16.2%, and the YLDs increased by 8.7%. Among those aged 5 to 14 years, the prevalence increased and the YLDs decreased.Dental caries remains a huge health burden in Western China. In contrast to the global and national data, the trend has increased rapidly over the past 25 years in this region. This work provides suggestions for the prevention and control for oral health in China with the policy of two-child.

To establish the distribution of 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Chinese adults.We estimated the 10-year ASCVD risk by applying the 2013 American College of Cardiology/ American Heart Association pooled cohort equations (PCEs) to the data obtained from the 2010 China Chronic Disease and Risk Factor Surveillance that involved 61,541 participants (representing 520,158,652 Chinese adults) aged 40-79 years. We also compared the ASCVD risk with the 10-year ischemic cardiovascular disease (ICVD) risk, which was calculated using the simplified scoring tables recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases (Chinese model).Based on the PCEs, the average 10-year ASCVD risk among adults without self-reported stroke or myocardial infraction was 12.5%. Approximately 247 million (47.4%) and 107 million (20.6%) adults had ⋝ 7.5% and20% 10-year ASCVD risks, respectively. The 10-year ASCVD risk20% was higher among men, less educated individuals, smokers, drinkers, and physically inactive individuals than among their counterparts. Overall, 29.0% of adults categorized using the Chinese model were overclassified with the PCEs.Our results define the distribution of 10-year ASCVD risk among Chinese adults. The 10-year ASCVD risk predicted by the PCEs was higher than the ICVD risk predicted by the Chinese model.

To explore the trend and characteristics of cardiovascular disease mortality in China.Mortality data from the National disease surveillance system from 2004 to 2010 was used. Underreporting was adjusted and trends were analyzed on the rates of crude mortality, standardized mortality and causes of death fraction among cardiovascular diseases.The total mortality of cardiovascular diseases increased from 240.03 to 268.92 per one hundred thousand during 2004 to 2010, with an average annual increase of 5.50 per one hundred thousand, with the annual increase of 2.17% . Data from all causes of death, ischemic heart disease, hypertensive heart disease, cerebrovascular disease, and other heart disease showed an upward trend, with the annual rise of 5.05%, 2.08%, 1.02% and 2.66% respectively while rheumatic heart disease showed a downward trend, with the declining rate of 7.02% per annum. After eliminating the effect of aging, the trend remained the same but the slope was decreasing. The proportion of national cardiovascular mortality on total deaths increased annually by 37.46% to 40.73% from 2004 to 2010. The proportion of cerebrovascular disease remained unchanging but the proportion of ischemic heart disease showed a significant increase. The proportion of rheumatic heart disease declined while the proportion of other cardiovascular disease mortality showing a slight change.In recent years, the cardiovascular mortality had significantly increased, which was mainly due to the increase of ischemic heart disease mortality.

To observe the mortality and its changes on liver cancer in the past 30 years as well as to describe the spatial distribution of liver cancer deaths between 2005 and 2010 in Lingbi, Anhui province.Using the mortality data from 1973-1975 and from 2005 to 2010 in Lingbi to compare with the relative national and historical data, to observe the trend of rapid increase on liver cancer mortality in Lingbi. Using the Poisson model, BYM model and hotspot detection method, standardized mortality ratio(SMR), relative risk(RR)value of liver cancer deaths of each village were calculated and the clustering of high liver cancer deaths was identified.Through an increase of 223.7% on the SMR of liver cancer in the past 30 years, the standardized mortality of liver cancer in Lingbi had an increase of 74.1 percent than the national level in 2005-2010 but it was 22.7% lower than the country level in 1973-1975. The SMR and RR values and their P values were higher in the villages which were located along the Kuisui River. Data from the clustering analysis showed that there had been significantly positive autocorrelation at the altitude of 5300 meters, and a very obvious hot spot of liver cancer deaths existing along the Kuisui River, especially at the bifurcation of the old Sui River and new Sui River was observed.There was an alarming increase of liver cancer mortality in the past 30 years in Lingbi. The high mortality area mainly covered the villages along the Kuisui River, suggesting that there were common risk factors for hepatocellular carcinoma in the population at risk.

To expand the evidence base to inform future public policy aimed at accident prevention, we investigated the impact of different categories of injury on average life expectancy in China. We used data from the National Death Cause Registration Information System and National Maternity and Children Health Surveillance databases, as well as 2010 population data from the National Bureau of Statistics. We then calculated the average life expectancy of the Chinese population, in addition to life expectancy after eliminating injury-related mortality. The average life expectancy of the Chinese population in 2010 was 74.93 years. After eliminating deaths due to injuries, the fourth leading cause of mortality in China, average life expectancy increased by 1.36 years. When this was broken down by population sub-groups, these gains were 1.76 and 0.79 years in men and women, 0.94 and 1.56 years in urban and rural residents, and 1.11, 1.30, and 1.67 years for residents in the Eastern, Central and Western regions respectively. After eliminating all categories of injury, the average life expectancy of the Chinese population was found to increase by 1.36 years. This figure was higher for males and residents of rural areas and Western China.

To explore the association between mortality rate of hepatic carcinoma and the distance from Suihe River in Lingbi county, Suzhou, Anhui province.Using the disease mapping and spatial statistical analysis techniques,we described the spatial distributions of the mortality rate of hepatic carcinoma from 2005 to 2010 in Lingbi county. Taking the distance between villages and polluted rivers as proxy variable of environmental exposure, mortality rate of hepatic carcinoma in each village as dependant variable, and using the Glimmix model and Bayesian spatial model (BYM) to undertake the univariate and multivariate analysis, we investigatived the association between mortality rate of hepatic carcinoma and the water pollution of Suihe River in Lingbi county.Obvious clustering of high mortality rate of hepatic carcinoma along the polluted river was observed in Lingbi county. Results of Glimmix model showed that whether spatial autocorrelation was considered or not, closer to the polluted river has higher mortality rate of hepatic carcinoma. Results of univariate analysis of the BYM model showed that, compared with the villages far from the polluted river more than 12 km (the mortality rate of hepatic carcinoma was 33.12/100 000(1068/3 224 562) ), the RR values of the hepatic carcinoma mortality was 1.38(95%CI:1.06-1.82) for the villages apart from the polluted river within 6 km (the mortality rate of hepatic carcinoma was 42.48/100 000(777/1 829 064)), and 1.13 (95%CI:0.92-1.39) for villages apart from the river between 6 and 12 km (the mortality rate of hepatic carcinoma was 35.65/100 000(651/1 825 848)). In the BYM model multivariate analysis, adding the volume of fertilizer and pesticides used per cultivated area, GDP per capita to do multivariate analysis were, the relation between mortality rate of hepatic carcinoma and distance from polluted rivers remains unchanged.The mortality rate of hepatic carcinoma was associated with the exposure to the polluted river in Lingbi county. The polluted river may increase the hepatic carcinoma mortality of nearby residents.

To develop an automated coding software related to the underlying causes of death, based on the National Registration Information System on deaths, which could improve the quality of coding on the underlying causes of death in the conventional death surveillance system. Following the coding rules of the underlying death cause of ICD-10 and the design on principles of software of underlying death cause automated coding from some other countries, as well as in accordance with the coding strategy table from the USA, we implemented the automatization of the underlying death cause coding. Based on national registration information system on cause of death, an automated coding software of underlying death cause was developed with the coding correction rate closed to 85%. The automated coding software of underlying death cause could code the death cases of underlying death cause with high rate of correction, similar to that of the same kind software developed in other countries.

To study the characteristics of the effect of different temperatures on mortality of different cities through analyzing the relationship between mortality and meteorology of five Chinese cities.We get the demography and climate data of Beijing, Tianjin, Shanghai, Nanjing and Changsha cities from National Center of Disease Control and Prevention and Climate net respectively. Then we applied the R software and Distributed Lag Non-linear Models (DLNM) package to analyze our data and find the nonlinear and lag effects on mortality using DLNM.The city of Beijing and Tianjin are located in the temperate zone. And the climate of Shanghai, Nanjing, Changsha belong to subtropical monsoon climate. When the daily mean temperature arrived 30°C and on lag 0 day, the values of relative risk of effect of high mean temperature on mortality in Nanjing (1.31, 95%CI: 1.21 - 1.41) and Changsha (1.25, 95%CI: 1.13 - 1.39) are larger than that in Beijing (1.18, 95%CI: 1.12 - 1.25), Tianjin (1.18, 95%CI: 1.10 - 1.26) and Shanghai(1.15, 95%CI: 1.06 - 1.24). While the relative risk of effect of low mean temperature on mortality is lower and lasts for a longer lag time. During the whole lag time, the relative risk of effect of the lowest daily mean temperature of each city on mortality in Tianjin, Changsha, Beijing, Nanjing, and Shanghai is 3.41, 95%CI: 1.60 - 7.27, 2.15, 95%CI: 1.11 - 4.15, 2.24, 95%CI: 1.12 - 4.48, 2.80, 95%CI: 1.75 - 4.48, 1.53, 95%CI: 1.12 - 2.03, respectively. The cumulative effect of mean temperature on mortality appears like a U-shape. When on lag 0-1 day, the value of relative risk of effect of extremely high temperature and the highest mean temperature on mortality is larger than 1. While the effect of low temperature on mortality becomes obvious after lag 2 days.Depending on this research, extremely low temperature and the lowest mean temperature has a more obvious impact on mortality in the northern area than in the south. Extremely high temperature and the highest daily mean temperature is on the contrary. Meanwhile, different temperatures have different impacts on mortality in the same city: high temperature has an acute impact while there is a longer lag time in low temperature.

To explore the short-term impact of ambient PM(10) on daily non-accidental death, cardiovascular and respiratory death of residents in Beijing.Mortality data of residents in Beijing during 2006 to 2009 were obtained from public health surveillance and information service center of Chinese Center for Disease Control and Prevention, contemporaneous data of average daily air concentration of PM(10), SO(2), NO(2) were obtained from Beijing Environment Protection Bureau (year 2005 - 2006) and public website of Beijing environmental protection (year 2007 - 2009), respectively, contemporaneous meteorological data were obtained from china meteorological data sharing service system. Generalized addictive model (GAM) of time serial analysis was applied. In additional to the control of confounding factors such as long-term trend, day of the week effect, meteorological factors, lag effect and the effects of other atmospheric pollutants were also analyzed.During year 2006 to 2009, the number of average daily non-accidental death, respiratory disease caused death, cardiovascular and cerebrovascular diseases caused death among Beijing residents were 140.1, 15.0, 65.8, respectively;contemporaneous medians of average daily air concentration of PM(10), SO(2), NO(2) were 123.0, 26.0, 58.0 µg/m(3), respectively;contemporaneous average atmosphere pressure, temperature and relative humidity were 10.1 kPa, 13.5°C and 51.9%, respectively. An exposure-response relationship between exposure to ambient PM(10) and increased daily death number was found as every 10 µg/m(3) increase in daily average concentration of PM(10), there was a 0.1267% (95%CI: 0.0824% - 0.1710%) increase in daily non-accidental death of residents, 0.1365% (95%CI: 0.0010% - 0.2720%) increase in respiratory death and 0.1239% (95%CI: 0.0589% - 0.1889%) increase in cardiovascular death. Ambient PM(10) had greatest influence on daily non-accidental and cardiovascular death of the same day, while its greatest influence on respiratory death occurred 5 days later.The ambient PM(10) pollution increased daily non-accidental, respiratory disease caused, cardiovascular and cerebrovascular diseases caused deaths among residents in Beijing, and lag effect existed as for the effect of ambient PM(10) pollution on respiratory disease caused death.

To better understand and measure the status of hepatitis C virus (HCV) infection, we conducted a sero-epidemiological study using the remaining blood samples and data of the nationwide survey of hepatitis B in Chinese residents which was carried out in 2006.The anti-HCV reagent was screened out from the reagents by the HCV infection blood serum plate with anti-HCV positives or negatives. This plate recognized the Murex 3.0 and Ortho 3.0 reagents as gold standards. Anti-HCV in the blood samples were tested using this reagent and confirmed by Chiron HCV RIBA 3.0 reagents.Among the population aged 1 year to 59 year-olds, the overall prevalence rate of anti-HCV was 0.43% (95%CI: 0.33% - 0.53%), with the rates of anti-HCV among males and females as 0.46% and 0.40%, respectively. The prevalence rate of anti-HCV in urban area was 0.43%, and in rural area it was 0.43%. The prevalence rate of anti-HCV in the Eastern, Middle and Western areas were 0.37% (95%CI: 0.21% - 0.53%), 0.67% (95%CI: 0.40% - 0.94%) and 0.31% (95%CI: 0.20% - 0.42%) respectively. The prevalence rates of anti-HCV for the three areas did not show significant differences, statistically. The prevalence rate of anti-HCV in the South and North areas were 0.29% (95%CI: 0.21% - 0.52%) and 0.53% (95%CI: 0.38% - 0.64%) respectively.Our data revealed that China was in the low prevalence area for hepatitis C infection and the results also suggested that the comprehensive measures for HCV control and prevention had been successfully achieved in the country.

To understand the current status and trends of tuberculosis mortality rates in China.In 2010, 161 National Disease Surveillance Points representing all 31 mainland provinces, municipalities, and autonomous regions of China collected tuberculosis mortality surveillance data, including age, sex, region, and type of tuberculosis (all, pulmonary, and extra-pulmonary). The mortality rates of the three types of tuberculosis were compared between 2004 and 2010.In 2010, the mortality rates due to all tuberculosis, pulmonary tuberculosis, and extra-pulmonary tuberculosis were 4.69 (95% CI 4.54-4.84), 4.38 (4.23-4.52), and 0.31 (0.27-0.35) per 100 000 population, respectively. Mortality rates due to all tuberculosis and pulmonary tuberculosis were higher in males, the elderly, and those living in western and rural areas. From 2004 to 2010, the mortality rates due to all tuberculosis and pulmonary tuberculosis decreased by 36.02% and 37.70%, respectively, with an average annual rate of decline of 7.20% and 7.61%, respectively.Mortality rates due to tuberculosis have declined rapidly in China. The target of reducing the 1990 mortality rate by 50% by 2015 has already been achieved. However, the tuberculosis control program should pay more attention to high-risk groups, including the elderly and those living in underdeveloped areas.

To describe the status and characteristics of under-reporting of death cases within national disease surveillance system (DSPs).Six villages (communities) were selected in each of the 161 counties of DSPs by multi-stage random cluster sampling methods, the information of resident from 2006 to 2008 was collected, and a survey of the under-reporting deaths cases was carried out which covered 6 422 667 people in all. The under-reporting rate was estimated by ages, genders and regions. The mortality was compared before and after the adjustment of the under-reporting rate.The total crude rate of under-reporting of whole nation was 16.68% (6271/37 603), and after the adjustment by weight the rate was 17.44%; the under-reporting rate of urban areas was a bit lower than rural areas, which were 16.08% and 18.14% respectively (P0.01); the under-reporting rate of middle and west regions were higher than the east, which were 19.27%, 18.15% and 15.46% respectively (P0.01). The under-reporting rate of children of under-five years old was much higher than that of people of five and above-five years old, which were 34.95% and 16.90% respectively (P0.01). The gender difference was especially obvious in age group 0-4, for women 39.36% while 31.93% for men. After adjusted by under-reporting rate, the mortality rate of male raised from 6.38‰ to 7.74‰ and for female raised from 4.66‰ to 5.64‰. In the middle region, the mortality rate of male raised from 6.49‰ to 8.00‰ and for female raised from 4.59‰ to 5.73‰ after the adjustment. And the mortality rate of male in age group 0-4 raised from 2.48‰ to 3.64‰ and for female raised from 1.98‰ to 3.27‰. Of which in urban area, the mortality rate of male was much higher than female before the adjustment, which were 1.76‰ and 1.39‰ respectively; however, the mortality rate of male was a bit lower than female after the adjustment, which were 2.26‰ and 2.41‰ respectively. The mortality in male of five and above-five raised from 6.60‰ to 7.69‰ after the adjustment while in female raised from 4.80‰ to 5.77‰.There are regional and age-group differences of the under-reporting rate of the National Disease Surveillance System. The gender differences mainly shows in age 0-4.

To study the association between particulate matter less than 10 micron in aerodynamic diameter (PM(10)) and daily mortality among urban population in Tianjin.We collected data of air quality, daily mean temperature and relative humidity, and daily cause-specific death counts, and used generalized additive models to explore the relationship between ambient particulate matter and daily mortality, after adjusting the effects of long-term and seasonal trend, weather conditions and other gaseous pollutants, such as sulfur dioxide and nitrogen dioxide.An increase of 10 µg/m(3) in PM(10) was associated with 0.45% (95%CI: 0.21 - 0.69) non-accidental morality, 0.60% (0.29 - 0.91) circulatory morality and 0.82% (0.04 - 1.61) respiratory morality, respectively.Our findings indicated that the extent of exposure to PM(10) was significantly associated with daily mortality in urban population in Tianjin, especially with the mortality rates on circulatory and respiratory diseases.

To analyze the status and trend of injury deaths in Chinese people, and provide basic evidence for injury interventions.Data came from 2004-2005 the 3rd national retrospective sampling survey of death cause and covered 31 province-level regions and 160 surveillance spots in the interior of China, Total 142 660 482 person years were investigated. To describe the status of injury deaths, the crude death rate, years of potential life lost (YPLL), working years of potential life lost (WYPLL) and the standardized death rate were calculated. The population used for standardization was from census in 2000 and each five-year was counted as an age group; To analyze the trend of injury deaths, the constitution of the death causes were calculated based on the data of 1991-2000 national disease surveillance system which covered more than 10 000 000 population and 145 surveillance spots.The total number of residents in survey districts died of injury between 2004 and 2005 was 87 753 (male 59 664, female 28 089, urban 23 308, rural 64 445); the crude death rate of injury in China 2004-2005 was 61.51/100 000 and accounting for 10.10% of all deaths; the standardized death rate was 58.45/100 000, ranking the fourth among the main cause of death for Chinese people. The YPLL of injury was 1579.61 person years per 100 000 and the WYPLL was 1721.41 person years per 100 000. The crude death rate of injury was 81.76/100 000 in male and 40.31/100 000 in female; the standardized death rates were 79.96/100 000 and 36.25/100 000, respectively. Injury mortality in male was two times higher than that in female. The crude death rates of injury were 48.66/100 000 in urban area and 68.01/100 000 in rural area; the standardized death rate were 44.08/100 000 and 66.25/100 000, respectively; the mortality in rural area was 1.4 times higher than that in urban area. The mortality for the aged 15 - 44 was 48.94/100 000(35 497/72 531 671) and accounting for 40% of all deaths, injury was the first cause of death for the aged 15 - 44. During 2004-2005, the top five causes of death related to injury were traffic accidents, suicide, falls, drowning and poisoning; the cases were 29 669, 18 678, 10 901, 7752, 4857 respectively in survey districts; the crude death rate were 20.80/100 000, 13.09/100 000, 7.64/100 000, 5.43/100 000, 3.40/100 000 respectively. From 1991 to 2005, the proportion of all injury deaths due to traffic accident increased from 15.00% (1551/10 338) to 33.79% (14 792/43 774) which showed a rising trend, the proportion of all injury deaths due to suicide decreased from 26.66% (2756/10 338) to 20.46% (8599/43 774) and the proportion of all injury deaths due to fall increased from 5.15% (532/10 338) to 12.87% (5630/43 774).Injury is the primary cause of death resulting in premature death among Chinese people, traffic accident is the first cause of injury death. Since 1990s, the pattern of injury mortality of Chinese people has changed.

To assess the relationship between body mass index (BMI) and ischaemic heart disease (IHD) mortality, especially in populations with low mean BMI levels.We examined the data from a population-based, prospective cohort study of 220 000 Chinese men aged 40 - 79, who were enrolled in 1990 - 1991, and followed up ever since to 1/1/2006. Relative risks of the deaths from IHD by the baseline BMI were calculated, after controlling age, smoking, and the other potential confounding factors.The mean baseline BMI was 21.7 kg/m(2), and 2763 IHD deaths were recorded during the 15-year follow-up (6.8% of all deaths) program. Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. When baseline BMI was above 20 kg/m(2), there was a strongly positive association of BMI with IHD risk, with each 5 kg/m(2) higher in BMI associated with 21% (95%CI: 9% - 35%, P = 0.0004) higher IHD mortality. Below this BMI range, the association appeared to be reverse, with the risk ratios as 1.00, 1.11, and 1.14, respectively, for men with BMI 20 - 21.9, 18 - 19.9, and18 kg/m(2). The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up.Lower BMI was associated with lower IHD risk among people in the so-called 'normal range' of BMI values (20 - 25 kg/m(2)). However, below that range, the association might well be reversed.

Using both general growth balance (GGB) and synthetic extinct generations (SEG) methods to evaluate the underreporting of deaths in disease surveillance points (DSP) from 1991 to 1998.We used those two methods to estimate the underreport rate in DSP from 1991-1998. According to GGB method, death rate and the difference between entry rate and growth rate were regarded as independent and dependent variable, respectively, to fit a one-dimensional linear equation n(*)(x) - r(*)(x+) = [ln(k(1)/k(2))]/t + [(k(1)k(2))(0.5)/c]d(*)(x+). About SEG method, it was calculated by life expectancy at age 85 of national census in 2000 and an equation N(x) = integral(x)(infinity)D(a).exp[integral(x)(a)r(u)du]d(a). Then we drew scatter diagram to evaluate underreporting of average intercensal age-specific mortality rates, and made adjustment.By GGB method, the population count in 1998 was 87.29 percent as complete as the count in 1991. For the period of 1991 - 1998, the number of underreporting of deaths was 11.7 percent. The underreporting of average intercensal age-specific mortality rates was not high. However, when SEG method was used, the underreport rate became 48.0 percent. The underreporting of average intercensal age-specific mortality rates decreased significantly from younger to older age groups.GGB and SEG could reduce more cost than other underreporting-related survey, and evaluate the underreporting in a defined time period. GGB could also evaluate the underreporting rate of population and death. However, both these two methods had some limitations. There was big difference between the results when using SEG and GGB, suggesting that we should try to combine GGB and SEG methods to get the better results.

To understand the underreporting on death cases through web-based reporting system from medical institutions at county level and above as well as to evaluate the quality of death cases reporting through the system.A large-scale survey was conducted at 130 medical institutions based on stratified random sampling and to evaluate the underreporting and the quality of death cases reporting from medical institutions through data from survey and reporting system.In 2005, the total reporting rates were 78.25% at the county level and 37.93% at the institutes. Comparing with the results of 2004, these rates were going down slightly. The eligibility rate of reporting was 79.62%, increased when comparing with results of 2004. The percentage of obvious coding errors among deaths reported by county level and above medical institutions was 24.68%. A total of 5226 death cases were recorded from medical (outpatient and inpatient) sources. An average underreporting rate of 33.07% was found at the selected medical institutions. Statistical difference of underreporting rate was not found at medical institutions at different levels.Since the initiation of the web-based reporting system of death cases at medical institutes from county level and above, the timeliness of data reporting had been increasing remarkably. The system showed irreplaceable advantages. However, there still existed some problems such as the underreporting of death cases,the poor timeliness of reporting, and the poor accuracy of coding. In the meantime, it was noticed that repetitive work existed among medical institutions due to multi-systems, suggesting that it was necessary to establish a national life registration in China.

To study the quality of reporting network system on death cases among county and above levels' medical institutions.Data on variables related to county reporting rate, unit reporting rate, timeliness of reporting, eligibility rate of reporting, auditing rate, timeliness of auditing, eligibility rate of auditing, percentage of reporting deaths of medical institutes to deaths among total population, percentage of reporting deaths of county and above levels' medical institutes to deaths among estimated deaths at these institutes were collected and distribution of common coding errors was applied to the assessment of reporting deaths.The total reporting rates were: 82.58% at the county level, 42.79% at the units with auditing rate as 96.96%. The eligibility rate of reporting was 69.10% with eligibility rate of auditing as 73.58%. The percentage of reporting deaths from medical institutes to deaths among total population was 8.91%, and the percentage of reporting deaths of county and above levels' medical institutes to deaths among estimated deaths of these institutes was 30.76%. The percentage of obvious coding errors among deaths reported by county and above levels' medical institutes was as high as 22.87%.Network reporting system of death cases among county and above levels' medical institutes had remarkably increased the timeliness of data reporting system. Network reporting of data on death was the best opportunity to expand the coverage and to improve the quality of data reporting. Based on network reporting of death cases among county and above levels' medical institutes as well as deaths accrued at the communities should also be reported via this network in the eligible areas. The quality of coding on death causes among medical institutes were commonly poor, indicating that the training on ascertainment and coding of underlying death causes were quite essential.

To compare the characteristics of suicides in the four main demographic groups: urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China.A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country.Pesticide ingestion accounted for 58% (519) of all suicides and 61% (318/519) of deaths were due to unsuccessful medical resuscitation. A substantial proportion (37%) of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% (76/563) received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion (79%), the lowest prevalence of mental illness (39%), and the highest acute stress from precipitating life events just prior to the suicide.Many suicides in China are impulsive acts of deliberate self-harm following acute interpersonal crises. Prevention of suicides in China must focus on improving awareness of psychological problems, improving mental health services, providing alternative social support networks for managing acute interpersonal conflicts, limiting access to pesticides, and improving the resuscitation skills of primary care providers.

To identify the most common life events that occurred prior to suicide in elderly individuals and the relationship of these life events to depressive symptoms.A detailed study considering life events in the year prior to death, the presence of mental illness at the time of death and the level of depressive symptoms in the 2 weeks prior to death was undertaken with the family members and other associates of 304 persons at 55 years of age and older who died of suicide.The three most common negative life events were acute or chronic physical illness or injury (59.2%), major changes in diet, sleeping or other daily routines (37.8%) and financial difficulties (34.5%). The severity of depressive symptoms was significantly greater among persons who had experienced these life events both for persons with or without definite mental illness.Most elderly persons who died of suicide events had experienced multiple negative life events in the year prior to death and these life events were closely related to the severity of depressive symptoms at the time of death.

The mortality and trend of injury in 1991 - 2000, the distribution of causes of injuries by areas as well as disease burden in Chinese population were discussed.Data on mortality level and causes of injuries provided by National Disease Surveillance Program in 1991 - 2000, adjusted by under-reporting rate together with years of potential life lost (YPLL) and WPYLL of injuries and proportion of YPLL and WPYLL of total death, were calculated.The mortality of injury was kept at a stable level from 1991 to 2000. The adjusted average death rates were 66.56/100,000 with 81.41/100,000 in males, 51.17/100,000 in females, and 38.68/100,000, 74.63/100,000 in urban and rural populations respectively. Death rates of injury in the east, central and west rural areas were 1:1.14:1.21 respectively. Injury was the main cause of death among children and youths. Traffic accident, suicide, drowning, poisoning and fall were main causes of injury accounting for 70 percent of all the injury mortality. Since 1990's, the death rate of traffic accident had been obviously increasing, YPLL and WPYLL in injury 2132 years/10,000 and 1587 years/10,000, respectively. The YPLL and WPYLL were 24.56% and 26.51% of total deaths.The disease burden of injury was heavy and the death of injury caused more social and economic losses owing to premature death. The increasing death rate of traffic accident called for more attention. Different effective control strategies should be formulated based on different death causes of injury and different target populations.