Key Social Determinants to Narrow the Gap between Health-adjusted Life Expectancy and Life Expectancy in Megacities

Objective Improvement in the quality of life is reflected in the narrowing of the gap between healthadjusted life expectancy(HALE)and life expectancy(LE).The effect of megacity expansion on narrowing the gap is rarely reported.This study aimed to disclose this potential relationship.Methods Annual life tables were constructed from identified death records and population counts from multiple administrative sources in Guangzhou,China,from 2010 to 2020.Joinpoint regression was used to evaluate the temporal trend.Generalized principal component analysis and multilevel models were applied to examine the county-level association between the gap and social determinants.Results Although LE and HALE in megacities are increasing steadily,their gap is widening.Socioeconomic and health services are guaranteed to narrow this gap.Increasing personal wealth,a growing number of newborns and healthy immigrants,high urbanization,and healthy aging have helped in narrowing this gap.Conclusion In megacities,parallel LE and HALE growth should be highly considered to narrow their gap.Multiple social determinants need to be integrated as a whole to formulate public health plans.

Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

Prevalence and Risk Factors for Chronic Obstructive Pulmonary Disease Among Adults Aged 50 and Above-10 CKB Study Areas,China,2020–2021

What is already known about this topic?The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults,but the risk factors for this age group were unclear.What is added by this report?The prevalence was estimated at 12.8%and 5.7%for males and females over 50 in 2020–2021,with confirmed risk factors of cigarette smoking,a family history of respiratory diseases,respiratory symptoms,and a history of cough or respiratory diseases during childhood.What are the implications for public health practice?The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.

Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population

Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high genetic risk.

Ideal cardiovascular health and mortality:pooled results of three prospective cohorts in Chinese adults

Background: Evidence on the relations of the American Heart Association’s ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. Methods: A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. Results: During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. Conclusions: ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

The Association Between Preserved Ratio Impaired Spirometry and Mortality –– 10 CKB Study Areas, China, 2004–2022

What is already known about this topic?China has the world’s most significant public health and economic burden of chronic respiratory disease.However,the association between preserved ratio impaired spirometry(PRISm)and mortality risk is unknown.What is added by this report?The PRISm group exhibited a 37%higher risk of allcause mortality than the normal group,and the risks of death from cardiovascular diseases,neoplasms,respiratory diseases,and infectious and parasitic diseases were also increased in PRISm.Moreover,the presence of respiratory symptoms or disease was associated with an increased risk of mortality in PRISm.What are the implications for public health practice?It is imperative to enhance public awareness of PRISm and to implement measures to facilitate the regression of PRISm toward normal lung function.

Associations of polygenic risk scores with risks of stroke and its subtypes in Chinese

Background and purpose Previous studies,mostly focusing on the European population,have reported polygenic risk scores(PRSs)might achieve risk stratification of stroke.We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population.Methods Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set(n=22191)and a population-based testing set(n=72150).Four previously developed PRSs were included,and new PRSs for stroke and its subtypes were developed.The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set.Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes(ischaemic stroke(IS),intracerebral haemorrhage(ICH)and subarachnoid haemorrhage(SAH)).Results In the testing set,during 872919 person-years of follow-up,8514 incident stroke events were documented.The PRSs of any stroke(AS)and IS were both positively associated with risks of AS,IS and ICH(p<0.05).The HR for per SD increment(HR_(SD))of PRSAS was 1.10(95%CI 1.07 to 1.12),1.10(95%CI 1.07 to 1.12)and 1.13(95%CI 1.07 to 1.20)for AS,IS and ICH,respectively.The corresponding HR_(SD) of PRS_(IS) was 1.08(95%CI 1.06 to 1.11),1.08(95%CI 1.06 to 1.11)and 1.09(95%CI 1.03 to 1.15).PRS_(ICH) was positively associated with the risk of ICH(HR_(SD)=1.07,95%CI 1.01 to 1.14).PRSS_(AH) was not associated with risks of stroke and its subtypes.The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification.Conclusions In this Chinese population,the association strengths of current PRSs with risks of stroke and its subtypes were moderate,suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population.

Combination patterns of precipitation and its concentration degree determining the risk of dengue outbreaks in China

The amount and distribution of precipitation can determine dengue risk by affecting mosquito breeding;however,previous studies failed to incorporate this bivariate characteristic to examine dengue fever transmission.In the present research,nationwide data on daily dengue cases in China between January 2005 and December 2020 were obtained,and the top 12 cities accounting for 78%of total cases were selected for analysis.Precipitation patterns were quantified by weekly precipitation and precipitation concentration degree(PCD).On the basis of the combinations of both parameters,the exposure-response relationships of precipitation with dengue risk were established using generalised additive models,and the high-dengue-risk thresholds of precipitation patterns were further identified.Dengue burden was assessed by calculating attributable dengue cases.For the same amount of precipitation,the dispersed precipitation in the pre-summer rainy season leads to a higher dengue risk in autumn.The weekly precipitation of 100-150 mm and PCD of 0.2-0.4 constitute the highest risk scenario,and the average frequency of precipitation associated with dengue risk in 2013-2020 is 1.6 times higher than that in 2005-2012.A total of 3093 attributable dengue cases are identified.From 2005 to 2020,the amount of dispersed precipitation increased in southern and southwestern China and posed high dengue risks in central China.This study has improved the understanding of the health impacts of irregular rainfall under climate change.Our approach to identifying thresholds provides information for early warning systems and helps reduce the risk of dengue transmission in the long run.

Comparative Study on Physical Activity in Diabetic and Non-Diabetic Individuals and Influential Factors—China,2020–2021

Summary What is already known about this topic?The majority of Chinese patients with diabetes failed to achieve the level of physical activity recommended by clinical guidelines.What is added by this report?The prevalence of low-level physical activity was found to be greater in individuals diagnosed with diabetes.It was observed that patients with a protracted duration of diabetes demonstrated a propensity to participate in lower levels of physical activity compared to those with a shorter disease trajectory.The likelihood of engaging in low-level physical activity associated with diabetes was higher in rural inhabitants,those with medium-tier education,employed individuals,and individuals who had longer sleep durations.What are the implications for public health practice?Developing strategies and interventions to encourage greater involvement of Chinese diabetic patients in physical activity is essential.However,these strategies must take population characteristics into account.

Variations in the Prevalence of Anemia of Varying Severity Among Urban Non-Pregnant Women—China,2021

Summary What is already known about this topic?Anemia is a significant public health issue affecting women globally.Prior studies in China predominantly concentrated on anemia in pregnant or reproductiveage women,leaving a gap in available data concerning anemia in non-pregnant women of all age groups in China.

PM_(1)颗粒物长期暴露与高血压住院:一项基于中国南方大型社区队列的因果推断研究

Limited evidence exists on the effect of submicronic particulate matter(PM_(1)) on hypertension hospitalization. Evidence based on causal inference and large cohorts is even more scarce. In 2015, 36,271 participants were enrolled in South China and followed up through 2020. Each participant was assigned single-year, lag0–1, and lag0–2 moving average concentration of PM_(1)and fine inhalable particulate matter(PM2.5) simulated based on satellite data at a 1-km resolution. We used an inverse probability weighting approach to balance confounders and utilized a marginal structural Cox model to evaluate the underlying causal links between PM_(1)exposure and hypertension hospitalization, with PM2.5-hypertension association for comparison. Several sensitivity studies and the analyses of effect modification were also conducted. We found that a higher hospitalization risk from both overall(HR: 1.13, 95% CI:1.05–1.22) and essential hypertension(HR: 1.15, 95% CI: 1.06–1.25) was linked to each 1 μg/m3increase in the yearly average PM_(1)concentration. At lag0–1 and lag0–2, we observed a 17%–21% higher risk of hypertension associated with PM_(1). The effect of PM_(1)was 6%–11% higher compared with PM2.5. Linear concentration-exposure associations between PM_(1)exposure and hypertension were identified, without safety thresholds. Women and participants that engaged in physical exercise exhibited higher susceptibility, with 4%–22% greater risk than their counterparts. This large cohort study identified a detrimental relationship between chronic PM_(1)exposure and hypertension hospitalization, which was more pronounced compared with PM2.5and among certain groups.

Drawing on the Development Experiences of Infectious Disease Surveillance Systems Around the World

High-quality infectious disease surveillance systems are foundational to infectious disease prevention and control.Current major infectious disease surveillance systems globally can be categorized as either indicatorbased,which are more specific,or event-based,which are more timely.Modern surveillance systems commonly utilize multi-source data,strengthened information sharing,advanced technology,and improved early warning accuracy and sensitivity.International experience may provide valuable insights for China.China’s existing infectious disease surveillance systems require urgent enhancements to monitor emerging infectious diseases and improve the integration and learning capabilities of early warning models.Methods such as establishing multi-stage surveillance systems,promoting cross-sectoral and cross-provincial data sharing,applying advanced technologies like artificial intelligence,and cultivating professional talent should be adopted to enhance the development of intelligent and multipoint-triggered infectious disease surveillance systems in China.

Associations of muscle mass,strength,and quality with all-cause mortality in China:a population-based cohort study

Background It remains unclear about the association of muscle mass,strength,and quality with death in the general Chinese population of diverse economical and geographical backgrounds.The present study aimed to comprehensively examine such associations across different regions in China.Methods Based on the China Kadoorie Biobank study,the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer.Muscle mass and grip strength were measured using calibrated instruments.Arm muscle quality was defined as the ratio of grip strength to arm muscle mass.Low muscle mass,grip strength,and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index,grip strength,and arm muscle quality,respectively.Cox proportional hazards models yielded hazard ratios(HRs)and 95%confidence intervals(CIs)for risks of all-cause mortality in relation to muscle mass,strength,and quality.Results During a median follow-up of 3.98 years,739 participants died.The HR(95%CI)of all-cause mortality risk was 1.28(1.08–1.51)for low appendicular muscle mass index,1.38(1.16–1.62)for low total muscle mass index,1.68(1.41–2.00)for low grip strength,and 1.41(1.20–1.66)for low arm muscle quality in models adjusted for sociodemographic characteristics,lifestyle factors,and medical histories.Conclusion Low muscle mass,grip strength,and arm muscle quality are all associated with short-term increased risks of mortality,indicating the importance of maintaining normal muscle mass,strength,and quality for general Chinese adults.

Current Progress and Challenges to Tobacco Control in China

In May 2003,the World Health Organization(WHO)Framework Convention on Tobacco Control(FCTC)was released(1),which is an event of great significance in the history of tobacco control.The FCTC was signed by China in November 2003 and entered into force in January 2006.Although some achievements in tobacco control have been made over the past 15 years,much more progress is needed.In July 2021,the WHO Report on the Global Tobacco Epidemic(Report)was released.The Report evaluates and grades implementation of the 6 most effective strategies of the Monitor,Protect,Offer,Warn,Enforce and Raise(MPOWER)tobacco control package in 61 high-income countries,105 middleincome countries,and 29 low-income countries(2)(Table 1).This article summarizes current progress and challenges to tobacco control in China with reference to the Report.

Minimal improvement in coronary artery disease risk prediction in Chinese population using polygenic risk scores:evidence from the China Kadoorie Biobank

Background:Several studies have reported that polygenic risk scores(PRSs)can enhance risk prediction of coronary artery disease(CAD)in European populations.However,research on this topic is far from sufficient in non-European countries,including China.We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population.Methods:Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training(n=28,490)and testing sets(n=72,150).Ten previously developed PRSs were evaluated,and new ones were developed using clumping and thresholding or LDpred method.The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set.Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms.Prediction of the 10-year first CAD events was assessed using hazard ratios(HRs)and measures of model discrimination,calibration,and net reclassification improvement(NRI).Hard CAD(nonfatal I21-I23 and fatal I20-I25)and soft CAD(all fatal or nonfatal I20-I25)were analyzed separately.Results:In the testing set,1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years.The HR per standard deviation of the optimal PRS was 1.26(95%CI:1.19-1.33)for hard CAD.Based on a traditional CAD risk prediction model containing only non-laboratory-based information,the addition of PRS for hard CAD increased Harrell’s C index by 0.001(-0.001 to 0.003)in women and 0.003(0.001 to 0.005)in men.Among the different high-risk thresholds ranging from 1%to 10%,the highest categorical NRI was 3.2%(95%CI:0.4-6.0%)at a high-risk threshold of 10.0%in women.The association of the PRS with soft CAD was much weaker than with hard CAD,leading to minimal or no improvement in the soft CAD model.Conclusions:In this Chinese population sample,the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD.Therefore,this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.