The China Alzheimer Report 2022

China’s population has rapidly aged over the recent decades of social and economic development as neurodegenerative disorders have proliferated,especially Alzheimer’s disease(AD)and related dementias(ADRD).AD’s incidence rate,morbidity,and mortality have steadily increased to make it presently the fifth leading cause of death among urban and rural residents in China and magnify the resulting financial burdens on individuals,families and society.The‘Healthy China Action’plan of 2019-2030 promotes the transition from disease treatment to health maintenance for this expanding population with ADRD.This report describes related epidemiological trends,evaluates the economic burden of the disease,outlines current clinical diagnosis and treatment status and delineates existing available public health resources.More specifically,it examines the public health impact of ADRD,including prevalence,mortality,costs,usage of care,and the overall effect on caregivers and society.In addition,this special report presents technical guidance and supports for the prevention and treatment of AD,provides expertise to guide relevant governmental healthcare policy development and suggests an information platform for international exchange and cooperation.

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.

Trends of Mortality in End-Stage Liver Disease—China,2008–2020

Introduction:Liver cancer and cirrhosis represent the most prevalent forms of end-stage liver diseases(ESLDs).Notably,in China,deaths attributed to ESLDs contribute significantly to the global mortality rate of these disorders.Enhanced comprehension of the mortality profile associated with ESLDs in China could provide crucial insights into intervention prioritization,which could in turn help reduce the overall global burden of these diseases.Methods:Data were obtained from China’s Disease Surveillance Points system.The presentation includes both crude and age-standardized mortality rates,stratified by sex,residential location,and region.Using Joinpoint Regression,trends in annual mortality rates were estimated from the period of 2008 to 2020 and expressed as the average annual percentage change(AAPC).Results:In 2020,the gross mortality rate of ESLD stood at 30.08 cases per 100,000 individuals.A higher age-standardized ESLD mortality rate was observed in males and rural populations in comparison to their female and urban counterparts,respectively.Noticeably,the highest mortality rates associated with liver cancer and cirrhosis were reported in South and Southwest China,respectively.A positive correlation was noticed between age-specific ESLD mortality rates and advancing age.Interestingly,an annual decrease in the ESLD mortality rate was observed from 2008 to 2020.In urban contexts,the AAPC of cirrhosis was noted to be higher than that of liver cancer.Conclusions:The mortality rate associated with ESLDs in China decreased between 2008 and 2020.Nevertheless,the death burden attributable to ESLD continues to be alarmingly high.Future initiatives should prioritize the reduction of ESLD mortality in particular populations:males,elderly individuals,and those residing in rural regions of South and Southwest China.The emphasis of future interventions should beplaced on antiviral therapy for adults diagnosed with viral hepatitis,and on the prevention of hepatitis B virus(HBV)infection across all demographics.

Pulmonary Heart Disease Associated Mortality—China,2014–2021

Introduction:Over the latter half of the previous century,pulmonary heart disease(PHD)emerged as a significant public health issue in China.However,the current mortality rate is unknown.Utilizing the Multiple Cause of Death database,the present study aims to investigate the current state and progression of PHD-associated death in China.Methods:Data from the China National Mortality Surveillance System were used to analyze progression in mortality rates attributable to PHD from 2014 to 2021.To standardize population structure for each year during the investigation period,demographic information from the 2020 census was employed as the reference population.Agestandardized mortality rates(ASMR)were determined based on sex,urban-rural area,and region.To identify trends in ASMR,a joinpoint regression analysis was executed.Results:The ASMR of PHD exhibited a marked decrease,falling from 61.68 per 100,000 in 2014 to 28.53 per 100,000 in 2021.This downward trend was observable in both genders,all regions,and both urban and rural settings.The greatest ASMR values were documented in the western region.Comparative observations revealed a higher ASMR in rural areas versus urban ones and in males versus females.PHDassociated deaths predominantly occurred among older individuals,particularly those aged 80 and above.Chronic obstructive pulmonary disease(COPD)emerged as the principal underlying cause of death PHD-associated mortalities,accounting for between 87.41%and 93.42%of cases throughout the period 2014–2021.Conclusions:There was a declining trend in PHD mortality in China from 2014 to 2021,with COPD accounting for a significant proportion of these deaths.Given the high prevalence of COPD and the escalating population aging in China,PHD remains a significant health concern that warrants further attention.

Cardiovascular Disease Mortality—China,2019

Introduction:Cardiovascular disease(CVD)is the leading cause of death and has caused a heavy burden in China.China has about 106 million CVD patients,including 33 million with stroke.This study presents the latest cardiovascular mortality in China in 2019 to provide evidence for disease control and prevention.Methods:Mortality data from the China Death Surveillance Point System(DSP System)was used for CVD mortality estimation.A descriptive analysis was conducted to demonstrate the results.Results:A total of 5.09 million CVD deaths were estimated in China in 2019,with a mortality rate and age-standardized mortality rate of 364.5 per 100,000 population and 276.0 per 100,000,respectively.Stroke is the leading cause of death,and the mortality rate and age-standardized mortality rate(ASMR)were 171.6 per 100,000 and 130.0 per 100,000,respectively.The second major cause was ischemic heart diseases,and the mortality rate and ASMR were 147.3 per 100,000 and 142.1 per 100,000,respectively.Stroke and ischemic heart diseases were the two major causes of CVD deaths,which accounted for over 87%of all CVD deaths.Conclusions:Although age-standardized mortality of CVD continues to decline in China,the number of deaths is still increasing.Therefore,prevention and control efforts for CVD should be maintained.In order to achieve the“Healthy China 2030”goal of reducing the mortality rate of CVD in China,it is necessary to further strengthen the prevention,control,and treatment capacity of stroke.Meanwhile,increases in ischemic heart disease deaths in highly developed areas should be monitored.

Short-term Exposure to Fine Particles and Risk of Cause-Specific Mortality--China,2013-2018

What is already known about this topic?Short-term exposure to PM2.5 has been associated with population excess death.This issue is of critical concern in China given its high level of exposure to PM2.5 compared to that of the rest of the world.What is added by this report?Existing studies were conducted from 2013-2015 and have failed to capture the full effects of China’s actions towards cleaner air in recent years,such as the first Action Plan for Air Pollution Prevention and Control issued in 2013.This study uses the longest time series data to date from 2013-2018,provides the latest evidence on PM2.5 and cause-specific death nationwide,and identifies regional patterns of PM2.5-related effects as well as PM2.5-related susceptible populations.What are the implications for public health practice?This study suggests that the development of standards and the implementation of actions to clean the air and protect public health should be tailored to PM2.5-related sensitive diseases,susceptible populations,and regional patterns.

Mortality of Common Gastrointestinal Tract Cancers--Huai River Basin, 2008–2018

What is already known on this topic?Gastrointestinal(GI)tract cancer is a leading cause of death and produces a heavy disease burden.GI tract cancer in the Huai River Basin was reportedly higher than the national level during 2004–2006,while current mortality rates and variations have not been reported recently.What is added by this report?During 2008 to 2018,significant decreases were observed in the rates of esophageal cancer(from 28.5 to 13.2 per 100,000)and stomach cancer(from 32.1 to 16.5 per 100,000).There was no statistical difference for the mortality rates of colorectal cancer,which actually showed a significant increase among men aged 45 to 54 years and women aged below 55 years.Substantial disparities exist among different sexes,age groups,and geographical regions.What are the implications for public health practice?These results highlight that the mortality of GI tract cancers in the Huai River Basin in 2018 are similar to national levels and still produce a heavy disease burden.More attention is needed to provide important evidence for evaluating the improvement and remaining gaps in cancer prevention and control strategies in the Huai River Basin.

Incidence,Prevalence,and Mortality of Four Major Chronic Non-communicable Diseases—China,1990-2017

Introduction Chronic and non-communicable diseases(NCDs)have become an important public health concern in China.We aimed to estimate the incidence,prevalence,and mortality of four major NCDs including cardiovascular disease(CVD),cancer,chronic respiratory diseases(CRD),and diabetes in China during 1990-2017.Methods The general analytic framework of Global Burden of Diseases Study 2017(GBD 2017)was applied.Data from Disease Surveillance Point System,censuses,and Chinese Center for Disease Control and Prevention Cause-of-Death Reporting System were used for mortality estimates.National surveys,cancer registries,and published studies were used for incidence and prevalence estimates.Results In 2017,new cases for CVD,cancer,and diabetes were 13.5,4.6,and 3.3 million,an increase of 120.4%,159.7%,and 57.3%respectively compared with 1990.There were 9.6 million incident cases for CRD in 2017,a 4.9%decrease compared with 1990.A total of 8.1 million people died from cancer,CVD,CRD,and diabetes in China in 2017.There was a substantial decline in age-standardized mortality rate for CRD and a steady but slow decline for CVD and cancer.During 1990-2017,the age-standardized prevalence rate increased by 7.4%,135.2%,and 17.0%for CVD,cancer,and diabetes respectively.Conclusions and Implications for Public Health Practice The accumulated prevalence of the four major NCDs are increasing but the age-standardized mortality rate for CVD,cancer,and CRD has been on a decline during 1990-2017.More effective intervention strategies should be developed to deal with the continuously increasing burden caused by NCDs in China.

Cancer Mortality and Cause Eliminated Life Expectancy in Key Areas of Four Provinces——China,2008-2018

Introduction:Cancer is a major health problem in China.Integrated interventions have been implemented in key areas of Anhui,Henan,Jiangsu,and Shandong provinces with historically higher than average cancer mortality.Assessing the cancer mortality trend and its impact on life expectancy(LE)could help evaluate the effectiveness of interventions in these regions.Methods:Based on the National Cause-of-Death Surveillance,we analyzed the standardized mortality rate(SMR)of cancer,cause eliminated life expectancy(CELE),potential gains in life expectancy(PGLEs),and rate of life lost in key areas of 4 provinces from 2008 to 2018.Joinpoint program was used to compute the average annual percentage change(AAPC)of cancer mortality.Arriaga’s decomposition method was used to estimate the contribution of cancer to LE in each age group.Results:From 2008 to 2018,cancer SMR decreased in the study region(AAPC=−3.09%,P<0.001),which increased LE.The positive effect was the greatest in the 75-79 age group(0.120 years,2.90%),and the negative effect was the greatest in the 50-54 age group(-0.094 years,−2.20%).Compared to 2008,cancer CELE increased by 3.95 years,PGLEs increased by 0.32 years,and rate of life lost increased by 0.21%in 2018.Conclusions:Cancer SMR decreased in key areas of 4 provinces from 2008 to 2018.This change had a positive effect on the increase of LE.However,the rate of life lost due to cancer increased.Integrated interventions should continue to further reduce the cancer burden.

Association Between Ambient Temperature and Years of Life Lost from Stroke—30 PLADs,China,2013–2016

What is already known about this topic?Previous studies have mainly focused on the relationship between temperature and mortality from stroke,but analysis on the effects on years of life lost(YLL)is limited.What is added by this report?YLLs were used as the health outcome,and cold and hot weather were found to be significantly associated with an increase in YLLs from stroke and for different groups,with a stronger effect found to be associated with low temperature.What are the implications for public health practice?These findings could help identify vulnerable regions and populations that have a more serious temperaturerelated burden and to guide the practical and effective measures for stroke control from a YLL perspective.

Cancer Mortality--China, 2018

Introduction Cancer is an important public health concern with heavy disease burden in China.In 2017,cancer is the leading cause of death,with around 2.60 million deaths,which accounts for 26.07%of all deaths.This study aims to present cancer mortality in China in 2018 to provide evidence for cancer control and prevention.Methods Mortality data from China Cause of Death Reporting System(CDRS)and population data from National Bureau of Statistics are used for cancer mortality estimation.A descriptive analysis was conducted to demonstrate the results.

Changes in Life Expectancy of Respiratory Diseases from Attaining Daily PM_(2.5) Standard in China: A Nationwide Observational Study

Although exposure to air pollution increases the risk of premature mortality and years of life lost(YLL),the effects of daily air quality improvement to the life expectancy of respiratory diseases remained unclear.We applied a generalized additive model(GAM)to assess the associations between daily PM_(2.5) exposure and YLL from respiratory diseases in 96 Chinese cities during 2013–2016.We further estimated the avoidable YLL,potential gains in life expectancy,and the attributable fraction by assuming dailyPM_(2.5) concentration decrease to the air quality standards of China and World Health Organization.Regional and national results were generated by random-effects meta-analysis.A total of 861,494 total respiratory diseases and 586,962 chronic obstructive pulmonary disease(COPD)caused death from 96 Chinese cities were recorded during study period.Each 10 mg/m3 increase of PM_(2.5) in 3-day moving average(lag02)was associated with 0.16(95%CI:0.08,0.24)years increment in life expectancy from total respiratory diseases.The highest effect was observed in Southwest region with 0.42(95%CI:0.22,0.62)years increase in life expectancy.By attaining the WHO's Air Quality Guidelines,we estimated that an average of 782.09(95%CI:438.29,1125.89)YLLs caused by total respiratory death in each city could be avoided,which corresponded to 1.15%(95%CI:0.67%,1.64%)of the overall YLLs,and 0.12(95%CI:0.07,0.17)years increment in life expectancy.The results of COPD were generally consistent with total respiratory diseases.Our findings indicate that reduction in daily PM_(2.5) concentrations might lead to longer life expectancy from respiratory death.

Mortality and Causes of Death in Primary and Secondary School Students--China,2018

What is already known about this topic?There were approximately 1.23 million deaths reported among individuals aged 5-19 years worldwide in 2017.Limited attention has been paid to current mortality among primary and secondary school students aged 6-18 years in China.What is added by this report?In 2018,an estimated 28,519 deaths occurred among primary and secondary school students aged 6-18 years in China with an age-standardized mortality rate(ASMR)of 17.66 per 100,000.Substantial disparities existed among sexes,age groups,areas,and regions for different causes of death.Drowning,road traffic injuries,and leukemia were three leading causes of death.What are the implications for public health practice?Government support,legislation enforcement,multisectoral cooperation,and stakeholder engagement should be initiated to reduce premature deaths among primary and secondary school students in China,especially those due to injuries.