Epidemiology and current management of cardiovascular disease in China

The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current management of cardiovascular disease(CVD) in China. This section of the report highlights the epidemiological trends of CVD in China. It reveal a concerning rise in prevalence, with approximately 330 million affected individuals, including significant numbers with stroke, coronary artery disease(CAD), heart failure, and other conditions. CVD stands as the primary cause of mortality among both urban and rural populations, accounting for nearly half of all deaths in 2020. Mortality rates are notably higher in rural areas compared to urban centers since 2009. While age-standardized mortality rates have decreased, the absolute number of CVD deaths has increased, primarily due to population aging. Ischemic heart disease, hemorrhagic and ischemic strokes are the leading causes of CVD-related deaths. Notably, the burden of atherosclerotic cardiovascular disease has risen substantially, with atherosclerotic cardiovascular disease-related deaths increasing from 1990 to 2016. The incidence of ischemic stroke and ischemic heart disease has shown similar increasing trends over the past three decades. CAD mortality, particularly acute myocardial infarction, has been on the rise, with higher mortality rates observed in rural areas since 2016. The prevalence of CAD has increased significantly, with over 11 million patients identified in 2013. Studies assessing hospital performance in managing acute coronary syndrome reveal gaps in adherence to guideline-recommended strategies, with disparities in care quality across hospitals. However, initiatives like the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study and the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS) project aim to improve patient outcomes through enhanced care protocols. Moreover, advancements in medical technology, such as quantitative flow ratio-guided lesion selection during percutaneous coronary intervention, show promise in improving clinical outcomes for patients undergoing intervention.

Molecular epidemiology, characterization of virulence factors and antibiotic resistance profile of Streptococcus agalactiae isolated from dairy farms in China and Pakistan

Streptococcus agalactiae is one of the most common pathogens that cause bovine mastitis worldwide. Identifying pathogen prevalence and virulence factors is critical for developing prevention and control approaches. Herein, 1 161 milk samples from various dairy farms in China(n=558) and Pakistan(n=603) were collected between 2019–2021 and were subjected to S. agalactiae isolation. Prevalence, serotyping, virulence genes, and antibiotic-resistant genes of S. agalactiae were evaluated by PCR assay. All isolates were characterized for haemolysis, biofilm production, cytotoxicity, adhesion, and invasion on bovine mammary epithelial cells. The prevalence of S. agalactiae-induced mastitis in cattle was found to be considerably higher in Pakistan than in China. Jiangsu and Sindh provinces had the highest area-wise prevalence in China and Pakistan, respectively. Serotypes Ia and II were prevalent in both countries, whereas serotype III was found only in Pakistan. Moreover, all isolates tested positive for PI-2b gene but negative for PI-1 and PI-2a genes. All isolates harboured cfb, cylE, hylB, and fbsB virulent genes, whereas many of them lacked bibA, rib and bca. However, the absence of bac and scp genes in Chinese isolates and cspA in Pakistani isolates was noted, while spb1 and lmb were not detected in isolates of both countries. Pakistani isolates, particularly serotype Iapositive, had a considerably higher ability to produce biofilm, haemolysis, cytotoxicity, adhesion, and invasion than Chinese isolates. Most of the isolates were phenotypically resistant to tetracycline, erythromycin, and clindamycin and genotypic resistance was confirmed by the presence of ermA, ermB, tetM and tetO genes. Our study highlights the antimicrobial resistance profile and virulence-related factors contributing to the epidemiological spread of mastitis-causing S. agalactiae in China and Pakistan. The findings may facilitate future studies designed to develop improved treatment and control strategies against this pathogen.

Epidemiology and early screening strategies for colorectal cancer in China

China ranks the first worldwide in the number of new colorectal cancer(CRC) cases and CRC-related deaths. The increasing incidence of early-onset CRC in recent years highlights the challenges related to CRC screening and prevention. High-quality colonoscopy is the universally used gold standard for CRC screening. Risk assessment combined with a two-step screening strategy based on colonoscopy and non-invasive examinations was proven to be highly effective. However, systematic use of well-established risk factors associated with CRC, beyond age, could better identify those who might harbor advanced colorectal neoplasia, improve the diagnostic yield of current screening modalities, and optimize the selection of individuals who might benefit most from preventive strategies.“Personalization” and “Standardization” are the future development directions of CRC screening, from the initiation of screening in those at high risk for CRC to follow-up after treatment, which are the key to ensure the screening efficiency.

Stomach cancer burden in China: Epidemiology and prevention

In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.

Molecular Epidemiology of Enteroviruses Associated with Hand, Foot, and Mouth Disease in the Mainland of China

Hand, foot, and mouth disease （HFMD） is a common contagious illness which occurs worldwide both sporadically and in epidemics. The disease mainly affects, children and the typical symptoms, which may resolve spontaneously, include mucocutaneous papulovesicular lesions on the hands, feet, mouth, and buttocks. In rare cases, however, the patients may also develop neurological complications such as neurogenic pulmonary edema,

Studies on the Epidemiology and Etiology of Moldy Sugarcane Poisoning in China

Moldy sugarcane poisoning, an acute fatal food poisoning of unknown etiology, has occurred in 13 provinces in China. The epidemiological characteristics and clinical features were described. Evidence from laboratory studies indicates that 3-nitropropionic acid roduced by the fungus Arthrinium Spp. is the etiological factor of this food poisoning.

Epidemiology,etiology,and prevention of esophageal squamous cell carcinoma in China

Esophageal cancer is one of the most fatal diseases worldwide mainly because of its rapid progression and poor prognosis.Although the incidence of esophageal adenocarcinoma has markedly risen in North America and Europe in the past several decades, esophageal squamous cell carcinoma is still the predominant subtype of esophageal cancer, especially in China. It accounts for more than 90% of all esophageal squamous cell carcinoma cases in China. Geographical differentiation is one of the most distinctive characteristics of esophageal cancer. The progression, risk factors, and prognosis of these two subtypes of esophageal cancer differ. This study reviews the epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China, thereby providing systematic references for policy-makers who will decide on issues of esophageal cancer prevention and control.

Clinical epidemiology of gastric cancer in Hehuang valley of China:A 10-year epidemiological study of gastric cancer

AIM:To investigate the clinical epidemiological characteristics of gastric cancer in the Hehuang valley,China,to provide a reference for treatment and prevention of regional gastric cancer.METHODS:Between February 2003 and February2013,the records of 2419 patients with gastric cancer were included in this study.The patient’s characteristics,histological and pathological features,as well as the dietary habits of the patients,were investigated.RESULTS:The clinical data showed that adenocarcinoma was the leading histological type of gastric cancer in this area.Characteristics of gastric cancer in different ethnic groups and age showed that the 60.55-65.50years group showed the high incidence of gastric cancer in all ethnic groups.There were more male gastric cancer patients than female.Intestinal was the most common type of gastric cancer in the Hehuang valley.There was no significant difference in the proportion of sex in terms of Helicobacter pylori infection.The impact of dietary habits on gastric cancer showed that regular consumption of fried or grilled food,consumption of high-salt,high-fat and spicy food and drinking strong Boiled brick-tea were three important factors associated with gastric cancer in males and females.CONCLUSION:Differences existed in race,sex,and age of patients according to the epidemiology of gastric cancer in the Hehuang valley.Moreover,dietary habits was also an important factor contributing to gastric cancer.

Seroepidemiology of Helicobacter pylori infection in elderly people in the Beijing region, China

AIM:To investigate seroepidemiology of cagA+and vacA+strains of Helicobacter pylori(H.pylori)in an elderly population in Beijing and to determine risk factors for seropositivity.METHODS:A total of 2006 elderly persons(>60years)were selected using a random cluster sampling method in different parts of the Beijing area(urban,suburban and mountainous districts).Structured questionnaires were completed during home visits,including history of H.pylori infection,history of gastrointestinal diseases,diet types,hygiene habits,occupation and economic status.Blood samples(2 mL)were collected from each participant,and serum IgG antibodies to cagA,vacA and H.pylori urease antigens were measured by immunodetection.RESULTS:The prevalence of H.pylori infection in elderly subjects was 83.4%and the typeⅠH.pylori strain infection rate was 56%.The seroprevalence for typeⅠH.pylori strain infection in urban and suburbandistricts was higher than that in the mountainous areas(P<0.001).Elderly subjects who had previously performed manual labor or were in the young-old age group(age<75 years)had a higher seroprevalence of H.pylori infection than those who had previously performed mental labor or were in the oldest-old age group(age≥75 year)(P<0.05).The typeⅠH.pylori strain infection rate in the elderly with vegetarian diets was higher than in those eating high-protein foods(P<0.001).There was no significant difference in the prevalence of H.pylori strains between male and female elderly participants(P>0.05).CONCLUSION:TypeⅠH.pylori seroprevalence is higher in elderly people.The distribution of strains of H.pylori is significantly affected by age,area and dietary habits.

Meta-analysis on the epidemiology of gastroesophageal reflux disease in China

BACKGROUND No large-scale epidemiological survey on the prevalence of gastroesophageal reflux disease(GERD)in China has been conducted.China has a large population and a complex geographical environment.It is important to understand the prevalence and spatial distribution of GERD in China.AIM To explore the prevalence and the spatial,temporal,and population distributions of GERD in the natural Chinese population.METHODS We searched Chinese and English databases for literature on the prevalence of GERD in the natural Chinese population.The prevalence of GERD was pooled using a random-effects meta-analysis model.Subgroup analysis was performed according to time,region,and population.We used ArcGIS software to draw statistical maps and trend analysis charts.Spatial autocorrelation analysis was carried out using Geoda software.Spearman correlation analysis was used to assess the spatial distribution relationship between GERD and upper digestive tract tumours.RESULTS Altogether,70 studies involving 276014 individuals from 24 provinces of China were included.The overall pooled prevalence of GERD was 8.7%(95%CI:7.5%-9.9%)in China's Mainland.Over the past two decades,the prevalence of GERD in China has increased from 6.0%to 10.6%.GERD was more common in people aged 40-60,with body mass index≥24,and of Uygur ethnicity.The prevalence was higher in the west and east than in the centre,and there may be a local spatial autocorrelation between the Qinghai-Tibet Plateau and the southeast.GERD was correlated with gastric(r=0.421,P=0.041)and oesophageal tumours(r=0.511,P=0.011)in spatial distribution.CONCLUSION GERD is becoming common in China.The prevalence differs by region and population.The development of appropriate strategies for the prevention and treatment of GERD is needed.

Epidemiology of fatty liver in an islander population of China:a population-based case-control study

BACKGROUND: Because of difficulty in evaluating fatty liver disease in islander populations, we conducted a crosssectional study to investigate the prevalence of fatty liver and its risk factors inan islander population of East China. METHODS: Randomized multistage stratified cluster sampling from the islander population was used in a population-based case-control study. Then interview, physical examination, and ultrasonography were done. RESULTS: Univariate logistic-regression analysis showed that male gender, smoking, daily alcohol intake >= 20 g, duration of drinking >= 5 years, total alcohol intake >= 36.5 kg, hypertension and obesity were closely related to fatty liver (all P < 0.05). Multivariate stepwise logistic-regression analysis showed duration of drinking >= 5 years and obesity were closely related to fatty liver (both P<0.05), the oddsratio (OR) (95% CI) was 1.954 (1.364-2.799) and 7.014 (4.919-10.002), respectively. The prevalence of fatty liver in this district was 40.0%. The prevalence of fatty liver in the non-obese and < 5 years drinking group, the non-obese and >= 5 years drinking group, the obese and < 5 years drinking group and the obese and >= 5 years drinking group were 15.43%, 26.73%, 56.78% and 71.521/6, respectively. A doseresponse relation between the duration of drinking and fatty liver was not apparent. After stratification by obesity, we found that the severity of fatty liver on ultrasonography was positively correlated with the duration of drinking level in the obese and non-obese groups, Pearson's correlation coefficients were 0.29:3 in the obese group and 0.178 in the non-obese group (both P < 0.05). CONCLUSIONS: The duration of drinking >= 5 years and obesity were two important risk factors for fatty liver in the islander population of East China. The prevalence of fatty liver in this population was high. An alcoholic threshold effect may be more important than a doseresponse effect on the morbidity offatty liver.

Molecular Epidemiology and Sequencing of the G-L Intergenic Region of Rabies Viruses Isolated in China

一组 25 个狂犬病病毒(RABV ) ，从 24 条狗和一个人的盒子恢复了，在在 2004 和 2006 之间的中国从各种各样的区域被收集。G-L intergenic 区域的基因、种系发生的分析在 25 街 RABV 被执行孤立， CTN 疫苗 7 拉紧代。学习基于 519 bp 核苷酸顺序的比较，包含 G-L intergenic 区域。中国街紧张的核苷酸顺序相同从 95.5% ～ 100% 。种系发生的分析证明中国的所有孤立清楚地在 Lyssavirus 遗传型 1 支持了所有中国病毒的放置，他们根据他们的地理起源是分布式的。所有仔细中国紧张被联系，但是他们能仍然被划分成二个组：一些街紧张和一些 CTN 紧张。这研究基于 G-L Intergenic 区域的序列关于狂犬病病毒的分子的传染病学介绍细节。关键词狂犬病病毒 - 分子的传染病学 - G-L intergenic 区域 - 中国 CLC 数字 R373.33 基础条款：第 10 国家 five-year-plan (2004BA718 b03 ) 的关键技术 R&D

Epidemiology and risk factors of colorectal cancer in China

In China, colorectal cancer(CRC) ranked fourth and fifth in the highest incidence and mortality rates of all malignancies in 2018, respectively. Although these rates are below the world average, China placed first worldwide in the number of new CRC cases and CRC-related deaths because of its comparatively large population. This disease represents a threat to the health of population and incurs a heavy economic burden on the society and individuals. CRC has various risk factors, including age, sex, lifestyle, genetic factors, obesity, diabetes, gut microbiota status, and precancerous lesions. Furthermore, incidence and mortality rates of CRC are closely related to socioeconomic development levels, varying according to regional and population characteristics. Prevention is the main strategy to reduce incidence and mortality rates of CRC. This can be achieved through strategies stimulating lifestyle changes, healthy diet habits, and early screening for high-risk individuals. To reduce the burden of CRC, public health officials should promote prevention and management of modifiable risk factors through national policies. The rising incidence and mortality rates of CRC in China may be timely curbed by clarifying specific epidemiological characteristics, optimizing early screening strategies, and strictly implementing diagnosis and treatment guidelines. Thus, this study aimed to collect and report the current research status on epidemiology and risk factors of CRC in China.

Epidemiology of HIV/AIDS in China: recent trends

We used nationally reported cases (NCAIDS/China CDC,2016) and published literature to summarize up-to the end of 2015 epidemiologic trends in the HIV/AIDS epidemic in China.HIV-positive cases are distributed unevenly with most infections found in southwest China and the most affected population being men who have sex with men.Transmission mode of HIV infection has shifted from drug injection to sexual contact,which accounts for 95% of total reported cases.Two thirds of cases are from heterosexual transmission.Transmission pattern varies greatly throughout China.Some provinces in China reported heterosexual transmission accounted for over 90% of cases while other provinces reported homosexual transmission accounted for over 80% of cases.Patterns of heterosexually acquired HIV also vary widely,with 80% of cases attributed to commercial sex in some provinces,while in other provinces non-commercial extramarital sex accounted for over 70% of cases.Significant increase in HIV infection was observed among young students aged 15-24.China has successfully controlled blood transfusion-and injecting drug-related transmissions of HIV.Homosexual and non-commercial extramarital heterosexual transmissions have become new challenges for China's HIV/AIDS program.Urgent adoption of the UNAIDS/WHO 90-90-90 target will help overcome these new challenges.

Epidemiology of Human Immuno-deficiency Virus and Quality of Life for People Living with HIV/AIDS in China

HIV/AIDS is increasing in prevalence in China and spread of infection from highly risk populations to the general populations was recognized. Despite the fact, there are still only few scientific reviews on quality of life （QOL） for people living with HIV/AIDS （PLWHAs）. However, many PLWHAs are struggling with social and psychological influences such as substances abuse, cultural beliefs, depression, stigma, poverty, which can affect their QOL. Public unawareness about infection and disease, willingness to seek medical care and motivation to follow therapy are indirectly influencing health outcome. In 2003 Chinese government has established the so-called the ＂Four Frees and One Care＂ policy. The policy was officially implemented from 2004 in some areas, yet to date it is not implemented nationwide. This paper discussed the epidemiology of HIV, underlying psychosocial factors affecting PLWHAs and their impact on QOL. We put forward some recommendations for stakeholders, advocacy groups, non-government organizations and Chinese government.

Molecular Epidemiology of Coxsackievirus B1-5 Associated with HFMD in Fujian Province, China, 2011-2016

Hand,foot and mouth disease(HFMD)is a common infectious disease that usually affects children less than 5 years of age.HFMD is caused by human enteroviruses(HEVs).HEVs,members of the Enterovirus genus of the Picornaviridae(small RNA virus)family.

Factors Associated with Field Epidemiology Investigation: A Cross-sectional Study in China

The public health problem caused by disease outbreak cause increasing global concern. Field epidemiology investigation (FEI), which involves the timely use of epidemiology to solve urge nt public health problems, is a crucial core capacity for the public health workforce. When an acute public health problem occurs, there is an urge nt n eed to identify the origin, path, cases, and vulnerable population, and to implement timely intervention. FEI can be con ducted not only for in fectious disease epidemics but also for non-communicable events such as poisoning, vaccination accidents, and environmental pollution. While situations do not always meet the statutory standard of a public health emergency, it remains necessary to conductan in vestigation to prevent event from becoming a serious public health problem.

Epidemiology of stroke in urban and rural areas of the People's Republic of China:an analysis of stroke incidence rates in 1986

This paper reports the stroke incidence rates in the People’s Republic of China(PRC)in 1986.A total of 5790864 people from 199 locations sampled from all parts of the PRC(Taiwanprovince excluded)were investigated and among them 6367 complete stroke cases were found.Theincidence rate was 109.95 per 100000 people and its 95% CI was 107.25～112.65/100000.The inci-dence rate adjusted using the population composition of the urban and rural areas of the PRCin 1986 was 110.58/100000.The incidence rate standardized by the direct method using thePRC population in 1982 was 84.07/100000,and the incidence rate standardized using theworld standard population was 115.87/100000.The incidence rates of the various provinces werecounted respectively,and the relationship between the incidence rates and the geographical locationswas analysed correlatively and regressively.Positive correlation and linear regression were found be-tween the incidence rotes and the latitudes and the longitudes,that is to say,the incidence rates in-creased gradually from the south to the north and decreased progressively from the east to the westin the PRC.The stroke incidence rates were higher in urban districts than in outskirts inbig cities.When the distribution of case number in months was analysed using the methods of thetest for trend and circular distribution,a peak significant in statistics was found in January althoughit was not very high.The stroke incidence rates rose gradualy with age,and the relationship be-tween the incidence rates and age could he fitted with the Logistic curve.

EPIDEMIOLOGY OF GASTRIC CANCER IN CHINA

Gastric cancer is the leading cause in the deaths caused by cancer in China. The highest level area of mortality of gastric cancer is located in the eastern and northern China, such as Qinghai, Ningxia, Gansu Provinces, etc, while the lowest mortality area is located in Guangdung and Guangxi Provinces, In recent years the mortality of gastric cancer tends decrease steadily. The sex ratio is 2.06:1 (male:female), the mortality of gastric cancer remarkably increases at the age after 35 years old. The mortality of the minority nationality of Kazak is the highest, while that of the Miao nationalily is the lowest. The lower the level of economic income, the higher the mortality of gastric cancer is. There is also a relationship between the profession and the mortality of gastric cancer. The dietary factors are very important in the occurrence of gastric cancer: salted food, lack of protein, lack of fresh vegetables and fruits, irregular dietary habits, over eating at one time, heavy salty taste, eating quickly, eating piping hot food, eating hard food, etc; these factors are high risk factors of gastric cancer. Mentally, as having suffered severe mental impaction, often burdened of unhappy things, and belonging to the depressive mental type, these are high risk factors also. The distribution of mortality of gastric cancer is related to the display of the tertiary period stratum, and to the amount of intake of trace elements such as Zn, Ni, Se, etc. There is also a relationship between the occurrence of gastric cancer and chronic atrophic gastritis. The preventive measures of gastric cancer are: less or not intake of salted food; avoidance of heavy salty taste; more intake of rich protein food such as fresh meat, fish, eggs, milk and soybean products; taking more fresh vegetables and fruits; keeping an optimistic view at any time; improving water quality, etc.

A survey on the epidemiology of trauma and China trauma care training in subtropical regions of Hainan Province

Objective: To investigate the epidemiology of trauma patients in subtropical areas of Hainan Province and the improvement of the level of trauma treatment in China trauma care training (CTCT). Methods: From 01-01-2015 to 01-01-2016, the epidemiological data of 2476 patients with trauma were collected. From 01-01-2016 to 01-01-2017, 105 professional doctors and nurses in emergency surgery took part in CTCT, and their knowledge were compared before and after training. Results: There were 1656 male and 820 female trauma patients with 1614 cases in the middle and young age and 478 cases were the elderly. In terms of occupational distribution, 736 peasants, 574 workers and 458 retirees were involved. In May, the number of patients was the highest 332. October to January was the high-incidence season of trauma. In 24 hours a day: 11:00-13:00, 18:00-19:00, 23:00-03:00 were the high incidence periods. Referred to trauma sites, 904 cases of trauma happened on roads, 540 cases in family and 370 cases in restaurants or entertainment facilities. Through CTCT, the scores of the theoretical examination, the assessment of the trauma treatment skills and the field test scores of the emergency surgery practitioners were better than before (P<0.05).The misdiagnosis rate of severe trauma patients decreased from 26.21% to 15.36% (P<0.05). The mortality rate of severe trauma patients decreased from 18.67% to 13.94% (P<0.05). Conclusions:Trauma epidemiology in Hainan is closely related to its special geographical environment, which provides a reference for the prevention and treatment of trauma in Hainan, and some information for the government to formulate corresponding laws and regulations, as well as emergency plans and other relevant strategies. CTCT training improves the level of theoretical knowledge and first aid skills of medical personnel involved in trauma treatment. Health departments and medical education departments may consider extending CTCT training and continuing education programs to Hainan and other parts of China.