Assessment of disability weights at the provincial and city levels based on 93,254 respondents in Fujian,China:Findings from the Fujian disability weight measurement study

To the Editor:Disability weights(DWs)are essential factors to quantify health losses relating to non-fatal outcomes for estimates of disability-adjusted life years(DALYs).Although national and subnational sets of DWs were published recently in the Chinese mainland,[1]data from only 4925 participants who responded to population health equivalence(PHE)questions used to anchor the 0-1 DWs scale did not include participants from Fujian province.Moreover,it remains unknown whether people living in different cities share the same DWs.This study provided an alternative approach using non-parametric regression to locate the DWs scale,as used in European surveys,[2]aimed at measuring DWs at the provincial and subprovincial levels in Fujian.

Short-term effects of fine particulate matter constituents on myocardial infarction death

Existing evidence suggested that short-term exposure to fine particulate matter(PM_(2.5))may increase the risk of death from myocardial infarction(MI),while PM_(2.5) constituents responsible for this association has not been determined.We collected 12,927 MI deaths from 32 counties in southern China during 2011–2013.County-level exposures of ambient PM_(2.5) and its 5 constituents(i.e.,elemental carbon(EC),organic carbon(OC),sulfate(SO_(4)^(2-)),ammonium(NH_(4)^(+)),and nitrate(NO_(3)^(-)))were aggregated from gridded datasets predicted by Community Multiscale Air Quality Modeling System.We employed a space-time-stratified casecrossover design and conditional logistic regression models to quantify the association of MI mortality with short-term exposure to PM_(2.5) and its constituents across various lag days.Over the study period,the daily mean PM_(2.5) mass concentration was 77.8(standard deviation(SD)=72.7)μg/m^(3).We estimated an odds ratio of 1.038(95%confidence interval(CI):1.003-1.074),1.038(1.013-1.063)and 1.057(1.023-1.097)for MI mortality associated with per interquartile range(IQR)increase in the 3-day moving-average exposure to PM_(2.5)(IQR=76.3μg/m 3),EC(4.1μg/m^(3))and OC(9.1μg/m^(3)),respectively.We did not identify significant association between MI death and exposure to water-soluble ions(SO_(4)^(2-),NH_(4)^(+)and NO_(3)^(-)).Likelihood ratio tests supported no evident violations of linear assumptions for constituents-MI associations.Subgroup analyses showed stronger associations between MI death and EC/OC exposure in the elderly,males and cold months.Short-term exposure to PM_(2.5) constituents,particularly those carbonaceous aerosols,was associated with increased risks of MI mortality.

The mortality of lung cancer attributable to smoking among adults in China and the United States during 1990–2017

Background:Statistical data on the burden and relevant risk factors of lung cancer are valuable for policy-making.This study aimed to compare the mortality of lung cancer attributable to smoking stratified by sex and age among adults in China and the United States(US).Methods:We extracted age-standardized mortality rates of lung cancer during 1990-2017 using the comparative risk assessment framework of the 2017 Global Burden of Disease study.We performed an age-period-cohort analysis to estimate time trend of lung cancer mortality attributable to smoking.Results:During 1990-2017,the age-standardized mortality rate of lung cancer was increasing in China but decreasing in the US for both sexes.The mortality attributable to smoking in China showed a generally increasing trend,while a continuous decrease was observed in the US.The age-period-cohort analysis showed a similar trend of age effect among adults between China and the US:the mortality substantially increased from the 30-34 to 80-84 age group and subsequently decreased in the 90-94 age group.However,the period effect rapidly increased in Chinese adults during 1990-2017,while it tended to be stable in the US although it was still slightly increasing in women.The cohort effect generally peaked in the earlier cohort born in 1902-1906 in the two countries.Conclusions:During 1990-2017,the lung cancer mortality attributable to smoking and the period effect are generally increasing in Chinese adults;the mortality attributable to smoking is decreasing in the US adults,but the period effect tends to be stable.The rapid aging and prevalence of smoking may intensify the increasing mortality of lung cancer in China.

Short-term exposure to fine particulate matter constituents and mortality:case-crossover evidence from 32 counties in China

A growing number of studies associated increased mortality with exposures to specific fine particulate(PM_(2.5))constituents,while great heterogeneity exists between locations.In China,evidence linking PM_(2.5)constituents and mortality was extensively sparse.This study primarily aimed to quantify short-term associations between PM_(2.5)constituents and non-accidental mortality among the Chinese population.We collected daily mortality records from 32 counties in China between January 1,2011,and December 31,2013.Daily concentrations of main PM_(2.5)constituents(organic carbon(OC),elemental carbon(EC),nitrate(NO_(3)^(-)),sulfate(SO_(4)^(2−)),and ammonium(NH_(4)^(+)))were estimated using the modified Community Multiscale Air Quality model.Time-stratified case-crossover design with conditional logistic regression models was adopted to estimate mortality risks associated with short-term exposures to PM_(2.5)mass and its constituents.Stratification analyses were done by sex,age,and season.A total of 116,959 non-accidental deaths were investigated.PM_(2.5)concentrations on the day of death were averaged at 75.7μg m^(−3)(control day:75.6μg m^(−3)),with an interquartile range(IQR)of 65.2μg m^(−3).Per IQR rise in PM_(2.5),EC,OC,NO_(3)^(-),SO_(4)^(2−),and NH_(4)^(+)at lag-04 day was associated with an increase in non-accidental mortality of 2.4%(95%confidence interval,(1.0–3.7),1.7%(0.8–2.7),2.9%(1.6–4.3),2.1%(0.4–3.9),1.0%(0.2–1.9),and 1.6%(0.3–2.9),respectively.Both PM_(2.5)mass and its constituents were strongly associated with elevated cardiovascular mortality risks,but only PM_(2.5),EC,and OC were positively associated with respiratory mortality at lag-3 day.PM_(2.5)mass and its constituents associated effects on mortality varied among sex-and age-specific subpopulations.Differences in the seasonal pattern of associations exist among PM_(2.5)constituents,with stronger effects related to EC and NO_(3)^(-)in warm months but SO_(4)^(2−)and NH_(4)^(+)in cold months.Short-term exposures to PM_(2.5)compositions were positively associated with increased risks of mortality,particularly those constituents from combustion-related sources.