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.

A Projection of Life Expectancy Based on the Global Burden of Disease Study 2019—China,1990-2030

Life expectancy(LE)is an important indicator for the overall health of a population,usually refers to the total number of years a group of people at birth can expect to live,given existing age-specific mortality rates(1).Healthy China 2030,the national strategic health plan released in 2016,set a goal that by 2030,the average LE of Chinese residents should reach 79 years.To examine the success of the plan at its midterm stage,it is necessary to evaluate its achievements so far,and assess if the goal can be realized by 2030 in each provincial-level administrative division(PLAD)separately.

1990～2015年中国省级行政区医疗可及性和质量分析

医疗可及性和质量(healthcare access and quality index,HAQ)是反映医疗系统及时、有效地发现、管理、治疗从而避免疾病死亡能力的重要指标.本研究利用2015年全球疾病负担研究结果,比较2015年中国与全球主要国家的HAQ指数差异,同时分析1990~2015年期间中国疾病间、省级行政区间HAQ指数及其变化幅度的差异.2015年中国HAQ指数为74.2分,高出全球平均水平20.5分;中国HAQ指数与其期望值仅相差1.2分,此差距远低于全球平均水平(20.1分).1990~2015年中国在呼吸系统疾病(上呼吸道感染、慢性呼吸系统疾病)、计划免疫性疾病(白喉、百日咳、破伤风和麻疹)、通过常规手术治愈的疾病(阑尾炎和腹股沟、股骨和腹部疝)、孕产妇疾病、缺血性心脏病和医疗副作用表现出较高的HAQ.2015年北京、澳门、上海等9个省级行政区的HAQ指数达到80分以上;西藏、青海、贵州、新疆和云南的HAQ指数最低;且处于高和中高社会人口发展水平的大部分省级行政区,其HAQ指数均高于其相应的期望值.1990~2015年中国HAQ指数增长49.30%,其中长幅最大的省级行政区为新疆、江西、云南和陕西,均超过55%;长幅最小的省级行政区为西藏、香港和澳门.研究表明,1990~2015年间,中国医疗可及性和质量有较大程度的提高,但在不同疾病领域、不同省级行政区表现出的医疗可及性和质量及其改善程度差异较大.

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.

Trends in Stroke Mortality Rate--China,2004-2019

Introduction:Stroke has been the leading cause of death in China for decades.This study described the trends in stroke mortality in China from 2004 to 2019.Methods:Data was obtained from the National Disease Surveillance Point(DSP)system.A descriptive analysis was conducted.The adjusted mortality rate(AMR)and age-standardized mortality rate(ASMR)of stroke were calculated.Results:From 2004 to 2019,the ASMR substantially decreased,with a reduction of 39.8%,but the AMR stayed relatively stable.The mortality rate of stroke in rural areas was consistently higher than in urban areas.A geographical gradient in mortality of stroke was also apparent,with an increased rate in the western part of China and a decreased rate in the eastern part of China.In central China,the rate remained relatively stable.Conclusions:Although the ASMR of stroke continued to decline in China,the stagnant crude mortality rates suggested that China had not achieved sufficient decline to offset the demographic forces of population growth and ageing.More vigorous and effective prevention and treatment strategies are urgently needed to mitigate the disease burden of stroke in China,especially in areas with high stroke burden and limited resources.

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.

National Cancer Data Linkage Platform of China:Design,Methods,and Application

Background:The National Cancer Center(NCC)and China CDC cooperatively designed a National Cancer Data Linkage(NCDL)Platform to fulfill the task of sharing cancer outcome data through an automatic web-based system.Methods:NCC and China CDC established a web-based NCDL Platform to link death information from China CDC with the cancer database from NCC.Overall,76,708 cancer patients’data were analyzed to assess the feasibility and match rate of the NCDL Platform for 7 major cancers.Results:The function of the platform includes a data application and approval system,data linkage module,and results visualization system.Through the platform,38.9%cases were identified as deaths cases from the NCDL Platform in the first 3 years after cancer diagnosis.The linkage rate was highest in liver cancer and lowest in breast cancer.Conclusions:The NCDL Platform provides a powerful and efficient way to link national vital statistics with national cancer programs’data.Expanding cancer outcome data linkage may not only improve data collection efficiency,but also improve data use.

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--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.

Epidemiological characteristics of centenarian deaths in China during 2013-2020:A trend and subnational analysis

Background:Studies that comprehensively address the characteristics of centenarian deaths are rare.The present study aimed to depict the characteristics of centenarian deaths in China and their changing trends.Methods:Data on centenarian deaths between 2013 and 2020 were obtained from the national mortality surveillance system of China,including date,place of death(PoD),and underlying cause of death(CoD).Descriptive analyses were performed to understand the epidemiological characteristics,and a joinpoint regression model was adopted to examine the changing trends in the proportions of different PoDs,CoDs among centenarians,and centenarian deaths accounting for all deaths and deaths among people aged 65 years and older.Results:There were 46,938 registered centenarian deaths between 2013 and 2020 that included 34,311 females(73.10%)and 12,627 males(26.90%).January(12.05%),February(9.99%),and December(9.74%)were the top three months with the highest number of deaths.The proportions of deaths that occurred in homes,hospitals,and nursing homes were 81.71%,13.63%,and 2.68%,respectively.The proportion of deaths in nursing homes increased by 9.60%(95%confidence intervals[CIs],6.4-12.9%)from 2014 to 2020.Heart disease(35.72%)was the leading cause of death,followed by respiratory diseases(17.63%),cerebrovascular disease(15.60%),and old age(11.22%).The proportion of respiratory diseases decreased by 4.8%(95%CI,-8.8 to-0.7%),and the proportion of deaths from old age decreased by 2.3%(95%CI,-4.4 to-0.1%)per year.Shanghai had the highest proportions of deaths in hospitals(39.38%)and nursing homes(14.68%).Sichuan had the highest proportion of deaths attributed to respiratory diseases(32.30%),while Jiangsu(26.58%)and Zhejiang(23.61%)had the highest proportions of deaths from old age.Conclusion:Unlike other countries,centenarian deaths in China are characterized by a higher proportion of home and heart disease deaths,and this death pattern differs across provinces.