Smoking in China: findings of the 1996 National Prevalence Survey

Trends in Disease Burden Attributable to Tobacco in China, 1990-2017: Findings From the Global Burden of Disease Study 2017

In 2018, there were more than 371 million cigarette smokers and 12. 6 million electronic cigarette users, with 340.2 million non-smokers exposed to secondhand smoke (SHS) in China, which resulted in heavy tobacco-attributable disease burden. According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, SHS, and chewing tobacco. In this study, we aimed to evaluate the trends in deaths and disability-adjusted life years (DALYs) attributable to tobacco, smoking, SHS, and chewing tobacco by sex in China from 1990 to 2017 and to explore the leading causes of tobacco-attributable deaths and DALYs using data from the GBD 2017. From 1990 to 2017, the tobacco-attributable death rates per 100,000 people decreased from 75.65 [95% uncertainty interval (95% UI) = 56.23-97.74] to 70.90 (95% UI = 59.67-83.72) in females and increased from 198.83 (95% UI = 181.39-217.47) to 292.39 (95% UI = 271.28-313.76) in males. From 1990 to 2017, the tobacco-attributable DALY rates decreased from 2209.11 (95% UI = 1678.63-2791.91) to 1489.05 (95% UI = 1237.65-1752.57) in females and increased from 5650.42 (95% UI = 5070.06-6264.39) to 6994.02 (95% UI = 6489.84-7558.41) in males. In 2017, the tobacco-attributable deaths in China were concentrated on chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, and stroke. The focus of tobacco control for females was SHS in 1990, whereas smoking and SHS were equally important for tobacco control in females in 2017. Increasing tobacco taxes and prices may be the most effective and feasible measure to reduce tobacco-attributable disease burdens.

Province-specific smoking-attributable cancer mortality in China 2013

INTRODUCTION

Province-specific initiatives are at the forefront of tobacco control but limited studies have provided province-specific assessment of smoking-attributable cancer burden in China.

METHODS

We estimated the fraction of total and site-specific cancer mortality attributable to tobacco smoking in 31 provinces in mainland China. The population attributable fractions (PAFs) for cancer deaths due to smoking were calculated by Levin's formula using province-specific smoking prevalence data around 1998 (assuming a 15-year latency time) and relative risks from cohort studies and meta-analyses. The 95% confidence intervals (CIs) of PAFs were calculated by a Delta method. Cancer deaths were abstracted from cancer registry data of the 31 provinces in mainland China in 2013.

RESULTS

Overall, smoking contributed to a total of 421566 cancer deaths in mainland China in 2013 (19.46% of all cancer deaths), with 400701 of these deaths occurring in men (29.34%) and 20865 (2.61%) in women. The population attributable fractions ranged from 15.56% (95% CI: 9.12-21.82%) in Tibet to 35.09% (95% CI: 25.68-45.83%) in Guizhou among men, and from 0.28% (95% CI: 0.00-0.64%) in Hainan to 10.44% (95% CI: 4.86-16.32%) in Jilin among women. Cancers of lung and liver were the two main smoking-attributable cancers for both men and women.

CONCLUSIONS

Tobacco smoking was responsible for nearly 20% of all cancer deaths in mainland China, but the proportion of cancer deaths attributable to smoking varied substantially across provinces. More effective programs and innovative new strategies for local tobacco control are warranted to reduce the future burden of smoking-related cancers in all provinces of mainland China.

Catastrophic health expenditure: A comparative analysis of smoking and non-smoking households in China

Introduction

Smoking is hazardous to health and places a heavy economic burden on individuals and their families. Clearly, smoking in China is prevalent since China is the largest consumer of tobacco in the world. Chinese smoking and nonsmoking households were compared in terms of the incidence and intensity of Catastrophic Health Expenditures (CHEs). The factors associated with catastrophic health expenditures were analyzed.

Methods

Data for this study were collected from two waves of panel data in 2011 and 2013 from the national China Health and Retirement Longitudinal Study (CHARLS). A total of 8073 households with at least one member aged above 45 were identified each year. Catastrophic health expenditure was measured by the ratio of a household’s out-of-pocket healthcare payments (OOP) to the household’s Capacity to Pay (CTP). A panel logit random-effects model was used to examine correlates with catastrophic health expenditure.

Results

The incidence of catastrophic health expenditures for Chinese households with members aged 45 and above in 2011 and 2013 were 12.99% and 15.56%, respectively. The mean gaps (MGs) were 3.16% and 4.88%, respectively, and the mean positive gaps (MPGs) were 24.36% and 31.40%, respectively. The incidences of catastrophic health expenditures were 17.41% and 20.03% in former smoking households, 12.10% and 15.09% in current smoking households, and 12.72% and 13.64% in nonsmoking households. In the panel logit regression model analysis, former smoking households (OR = 1.444, P<0.001) were more prone to catastrophic health expenditures than nonsmoking households. Risk factors for catastrophic health expenditures included members with chronic diseases (OR = 4.359, P<0.001), hospitalized patients (OR = 8.60, P<0.001), elderly people aged above 65 (OR = 1.577, P<0.001), or persons with disabilities (OR = 1.275, P<0.001). Protective factors for catastrophic health expenditures included being in an urban household, having a larger family size, and having a higher household income.

Conclusions

The incidence of catastrophic health expenditures in Chinese households is relatively high. Smoking is one of the primary risk factors for catastrophic health expenditures. Stronger interventions against smoking should be made in time to reduce the occurrence of health issues caused by smoking and the financial losses for individuals, families and society.

Preconception blood pressure and risk of gestational hypertension and preeclampsia: a large cohort study in China

Our objective was to examine whether high blood pressure in the preconception period was associated with gestational hypertension and preeclampsia in Chinese women. Data were obtained from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. We included 45,628 women who were registered before pregnancy in seven counties in South China. Blood pressure was measured during registration by trained health care workers, and other health-related information was recorded prospectively. We used logistic regression to evaluate the associations between preconception blood pressure and the risk of gestational hypertension and preeclampsia, adjusting for potential confounders. The prevalence of hypertension in the preconception study population was 4.57% (2083/45,628). The incidences of gestational hypertension and preeclampsia were 11.95% and 4.08%, respectively, in the hypertension group and 8.60% and 2.28%, respectively, in the nonhypertension group. Compared with the nonhypertension group, the hypertension group showed a significantly increased risk for gestational hypertension [adjusted risk ratio (RR) = 1.40, 95% confidence interval (CI): 1.22-1.60] and preeclampsia [adjusted RR = 1.75, 95% CI: 1.39-2.19]. When participants with normal blood pressure were used as the reference, the adjusted ORs for gestational hypertension were 1.48 (95% CI: 1.37-1.59), 1.70 (95% CI: 1.44-2.01), and 1.29 (95% CI: 1.02-1.64), and for preeclampsia, the adjusted ORs were 1.55 (95% CI: 1.35-1.78), 1.95 (95% CI: 1.46-2.60), and 1.99 (95% CI: 1.39-2.85) for the participants with prehypertension, stage 1 hypertension, and stage 2 hypertension, respectively. Our results support an association between hypertension or higher blood pressure prior to pregnancy and an increased risk of gestational hypertension and preeclampsia.

Association between environmental tobacco smoke exposure and risk of type 2 diabetes mellitus in Chinese female never smokers: A population-based cohort study

BACKGROUND

Evidence for the association between environmental tobacco smoke (ETS) exposure and the risk of type 2 diabetes mellitus (T2DM) is limited. The aim of this study was to investigate this association in female never smokers.

METHODS

We analyzed 28 177 female participants of the China Kadoorie Biobank (CKB) in the Suzhou area, who were never smokers and had no diabetes. ETS exposure was defined as being exposed to other people's tobacco smoke either at home, workplace, or in public places at least 1 d/wk. Cox proportional hazard regression models were used to assess the association between ETS exposure and incident T2DM according to the frequency and duration of ETS exposure.

RESULTS

A total of 774 incident cases of T2DM were identified during a median 7.3-year follow-up. Compared with no ETS exposure, hazard ratios (95% CIs) for all ETS exposure, daily, and ≥14 h/wk ETS exposure were 1.17 (1.00-1.37), 1.23 (1.04-1.46), and 1.25 (1.03-1.53), respectively. Moreover, a positive dose-response relationship was observed between ETS exposure level and T2DM (all P <.05 for trend).

CONCLUSIONS

This prospective study suggests that ETS exposure increases the risk of T2DM incidence with dose-response relationship in female never smokers. Thus, reducing ETS exposure may help decrease the burden of T2DM in Chinese females.

Lung cancer occurrence attributable to passive smoking among never smokers in China: a systematic review and meta-analysis

Background

Quantifying the occurrence of lung cancer due to passive smoking is a necessary step when forming public health policy. In this study, we estimated the proportion of lung cancer cases attributable to passive smoking among never smokers in China.

Methods

Six databases were searched up to July 2019 for original observational studies reporting relative risks (RRs) or odds ratios (ORs) for the occurrence of lung cancer associated with passive smoking in Chinese never smokers. The population attributable fraction (PAF) was then calculated using the combined proportion of lung cancer cases exposed to passive smoking and the pooled ORs from meta-analysis. Data are reported with their 95% confidence intervals.

Results

We identified 31 case-control studies of never smokers and no cohort studies. These comprised 9,614 lung cancer cases and 13,093 controls. The overall percentages of lung cancers attributable to passive smoking among never smokers were 15.5% (9.0-21.4%) for 9 population-based studies and 22.7% (16.6-28.3%) for 22 hospital-based studies. The PAFs for women were 17.9% (11.4-24.0%) for the population-based studies and 20.9% (14.7-26.7%) for the hospital-based studies. The PAF for men was only calculable for hospital-based studies, which was 29.0% (95% CI: 8.0-45.2%). Among women, the percentage of lung cancer cases attributable to household exposure (19.5%) was much higher than that due to workplace exposure (7.2%).

Conclusions

We conclude that approximately 16% of lung cancer cases among never smokers in China are potentially attributable to passive smoking. This is slightly higher among women (around 18%), with most cases occurring due to household exposure.

Polycyclic aromatic hydrocarbons exposure and their joint effects with age, smoking, and TCL1A variants on mosaic loss of chromosome Y among coke-oven workers

Mosaic loss of chromosome Y (mLOY) is the most common structure somatic event that related to increased risks of various diseases and mortality. Environmental pollution and genetic susceptibility were important contributors to mLOY. We aimed to explore the associations of polycyclic aromatic hydrocarbons (PAHs) exposure, as well as their joint effects with age, smoking, and genetic variants on peripheral blood mLOY. A total of 1005 male coke-oven workers were included in this study and their internal PAHs exposure levels of 10 urinary PAH metabolites and plasma benzo[a]pyrene-r-7,t-8,t-9,c-10-tetrahydotetrol-albumin (BPDE-Alb) adducts were measured. mLOY was defined by the median log R ratio(mLRR) of 1480 probes in male-specific region of chromosome-Y from genotyping array. We found that the PAHs exposure levels were linearly associated with mLOY. A 10-fold increase in urinary 1-hydroxynaphthalene (1-OHNa), 1-hydroxyphenanthrene (1-OHPh), 2-OHPh, 1-hydroxypyrene (1-OHP), ΣOH-PAHs, and plasma BPDE-Alb adducts could generate 0.0111, 0.0085, 0.0069, 0.0103, 0.0134, and 0.0152 decrease in mLRR-Y, respectively. Additionally, mLOY accelerated with age, smoking pack-years, and TCL1A rs1122138-C allele, and we observed the most severe mLOY among subjects carrying more than 3 of the above risk factors. Our results revealed the linear dose-effect associations between PAHs exposure and mLOY. Elder male smokers carrying rs1122138CC genotype were the most susceptible subpopulations to mLOY, who should be given protections for PAHs exposure induced chromosome-Y aberration.

Effectiveness of a clinic-based randomized controlled intervention for type 2 diabetes management: an innovative model of intensified diabetes management in Mainland China (C-IDM study)

OBJECTIVES

Highly efficient diabetes management programs are needed for tackling diabetes in China. This study aimed to assess the effectiveness of a clinic-based intensified diabetes management model (C-IDM) in Mainland China.

RESEARCH DESIGN AND METHODS

A 2-year clinic-based randomized controlled trial was conducted among patients with type 2 diabetes in Nanjing, China. The C-IDM intervention components comprised four domains (disease targeting management, express referral channel, expert visit, patients' self-management) and an integrated running system (disease control centers, general hospitals and local clinics). Control group participants received their usual care, while intervention participants received both the C-IDM package and the usual services. The primary outcome variable was change of hemoglobin A1c (HbA1c). Mixed-effects models were used to compute effect estimates and 95% CI with consideration of both individual and cluster-level confounders.

RESULTS

Overall, 1095 of 1143 participants were assessed at study completion. The mean change in HbA1c was significantly greater in the intervention group than in the control group (mean difference (MD)=-0.57, 95% CI -0.79 to -0.36). Similar results were observed for change in body mass index (MD=-0.29, 95% CI -0.49 to -0.10). Participants in the intervention group were more likely to achieve normal HbA1c and body weight compared with their counterparts in control group after adjusting for potentially confounding variables (adjusted OR=1.94, 95% CI 1.35 to 2.81 and 1.79, 95% CI 1.13 to 2.85, respectively).

CONCLUSIONS

The C-IDM model is feasible and effective in large-scale management of patients with type 2 diabetes in China. It has public health implications for tackling the burden of diabetes in China.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15006019.

Down expression of lnc-BMP1-1 decreases that of Caveolin-1 is associated with the lung cancer susceptibility and cigarette smoking history

Lnc-BMP1-1 is a lncRNA transcribed from SFTPC (surfactant associated protein C), a lung tissue specific gene encoding pulmonary-associated surfactant protein C (SPC) that is solely secreted by alveolar typeⅡ epithelial cells, among which the ones with SFTPC+ might be transformed into lung adenocarcinoma cells. Caveolin-1 (Cav-1) is a candidate tumor suppressor gene and is vital for coping with oxidative stress induced by cigarette smoke. When comparing lung cancer tissues with their adjacent normal tissues, the expression of lnc-BMP1-1 were decreased, especially in patients with cigarette smoking history (P=0.027), and positively associated with the expression of Cav-1 (P<0.001). When comparing to A549 cells transfected with empty vector (A549-NC cells), the expression level of Cav-1 in A549 cells with over-expressed lnc-BMP1-1 (A549-BMP cells) was increased along with the decreased level of HDAC2 protein. The drug sensitivity of A549-BMP cells to Doxorubicin hydrochloride (DOX) was increased; the growth and migration capability of A549-BMP cells were inhibited along with the decreased protein level of Bcl-2 and DNMT3a; the growth of tumor in nude mice injected with A549-BMP cells were inhibited, too. Furthermore, the lnc-BMP1-1 and Cav-1 expression was also down-regulated in the human bronchial epithelial (16HBE) cells treated with cigarette smoke extract (CSE).

Trends and risk factors of lung cancer in China

China is faced with heavy burdens caused by lung cancer, which has climbed to the top of both cancer incidence and mortality spectrums. The age-standardized rates of incidence and mortality have shown a trend of gradual up-trends in the last decades, while the crude rates rise much quickly due to the aging of population. Although the improvement in health care has contributed to better survival of lung cancer, its prognosis is still challenging. Apart from the common risk factors such as tobacco use, air pollution, and occupational hazards, some specific factors like Chinese-style cooking also have posed great threats to human health. In light of such national conditions, specific interventions should be conducted to curb the burden of lung cancer including smoking cessation, improvement of air quality, early detection and effective treatment of lung cancer.

Association between Abdominal Fat Distribution and Free Triiodothyronine in a Euthyroid Population

BACKGROUND

Obesity is closely related to thyroid hormones; however, the relationship between abdominal fat distribution and thyroid hormones has rarely been explored.

OBJECTIVES

This study aimed to explore the relationship between abdominal fat distribution and free triiodothyronine (FT3) and FT3 to free thyroxine (FT4) ratio (FT3/FT4) in a euthyroid population.

METHODS

The present study enrolled 1,036 participants (age range 27-81 years; 445 men and 591 women). The visceral fat area (VFA) and the subcutaneous fat area (SFA) were determined by magnetic resonance imaging. FT3, FT4, and thyroid-stimulating hormone were measured by an electrochemical luminescence immunoassay.

RESULTS

In both men and women, SFA increased according to the increase of FT3 and FT3/FT4 tertiles (p for trend <0.05), while VFA did not significantly change. In the multivariate stepwise regression analysis, SFA was independently and positively related to FT3 in both men and women, the standardized β (95% CI) were 0.183 (0.094, 0.272) (p < 0.001) and 0.089 (0.007, 0.171) (p = 0.033), respectively. Moreover, SFA was independently and positively related to FT3/FT4 in men, the standardized β (95% CI) was 0.196 (0.101, 0.290) (p < 0.001). However, VFA was not related to either FT3 or FT3/FT4 in both genders.

CONCLUSIONS

Abdominal subcutaneous fat was independently related to increased FT3 in a euthyroid population.

Neck Circumference is an Effective Supplement for Nonalcoholic Fatty Liver Disease Screening in a Community-Based Population

BACKGROUND

Accumulating evidence has shown that neck circumference (NC) is associated with obesity-related metabolic abnormalities. Nonalcoholic fatty liver disease (NAFLD) is regarded as a liver manifestation of metabolic syndrome. This study aimed to investigate the relationship between NC and liver fat content (LFC) and NAFLD.

METHODS

A total of 1698 subjects (577 men and 1121 women) from the Shanghai community were enrolled. All the subjects underwent NC measurement and biochemical measurements. LFC was calculated using the parameters from abdominal ultrasound images. Elevated NC was defined as NC ≥38.5 cm in men and NC ≥34.5 cm in women.

RESULTS

Subjects with NAFLD based on the LFC measurement had higher values of NC, liver enzyme profiles, homoeostasis model assessment-insulin resistance index, and LFC than those without NAFLD (all P < 0.05), irrespective of sex. NC showed an upward trend with the increase of LFC in both men and women (both P < 0.05). An elevated NC could identify 55.22% of men and 50.29% of women with NAFLD based on quantitative ultrasonography. The positive correlation between NC and LFC remained significant even after adjustment for central obesity (both P < 0.05). After adjusting for confounding factors, the risk of NAFLD in subjects with an elevated NC was 1.52-fold higher in men (P=0.036) and 2.31-fold higher in women (P < 0.001).

CONCLUSIONS

There was a significant and positive correlation between NC and LFC. The risk of NAFLD increased significantly in subjects with an elevated NC.

Sleep duration, midday napping, and sleep quality and incident stroke

Objective

To investigate the associations of sleep duration, midday napping, sleep quality, and change in sleep duration with risk of incident stroke and stroke subtypes.

Methods

Among 31,750 participants aged 61.7 years on average at baseline from the Dongfeng-Tongji cohort, we used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident stroke.

Results

Compared with sleeping 7 to <8 hours/night, those reporting longer sleep duration (≥9 hours/night) had a greater risk of total stroke (hazard ratio [HR] 1.23; 95% confidence interval [CI] 1.07–1.41), while shorter sleep (<6 hours/night) had no significant effect on stroke risk. The HR (95% CI) of total stroke was 1.25 (1.03–1.53) for midday napping >90 minutes vs 1–30 minutes. The results were similar for ischemic stroke. Compared with good sleep quality, those with poor sleep quality showed a 29%, 28%, and 56% higher risk of total, ischemic, and hemorrhagic stroke, respectively. Moreover, we observed significant joint effects of sleeping ≥9 hours/night and midday napping >90 minutes (HR 1.85; 95% CI 1.28–2.66), and sleeping ≥9 hours/night and poor sleep quality (HR 1.82; 95% CI 1.33–2.48) on risk of total stroke. Furthermore, compared with persistently sleeping 7–9 hours/night, those who persistently slept ≥9 hours/night or switched from 7 to 9 hours to ≥9 hours/night had a higher risk of total stroke.

Conclusions

Long sleep duration, long midday napping, and poor sleep quality were independently and jointly associated with higher risks of incident stroke. Persistently long sleep duration or switch from average to long sleep duration increased the risk of stroke.

Does passive smoking at home lead to depression among older people in China?

BACKGROUND

This paper was carried out based on two motivations: (a) prior studies achieved mixed results regarding the effect of passive smoking on depression; and (b) studies on the impacts of passive smoking usually neglect effects on older people. In our paper, we studied the causal effect of passive smoking at home on depression among older people aged 60 years and older in China with a longitudinal study.

METHODS

In assessing the causal relationship, we developed a fixed-effects instrumental variable method using an exogenous variable-health consciousness and the smoking status of parents-as instruments of smoking status. We used data from the China Health and Retirement Longitudinal Study (CHARLS), which provides a national, high-quality, and longitudinal household survey of people aged 45 years and older.

RESULTS

Our empirical results reveal that passive smoking at home increased the depressive symptoms of older people, regardless of their smoking status. Moreover, the impact of passive smoking on depression is larger for nonsmokers than smokers. Additionally, the health consciousness and smoking status of parents are effective instrumental variables.

CONCLUSIONS

This paper calls for governments and medical institutions to pay more attention to the health of older people and their need for healthy living environments.

Inverse association between physical activity and blood glucose is independent of sex, menopause status and first-degree family history of diabetes

AIMS/INTRODUCTION

Exercise training is a recognized strategy central to the prevention, treatment, and management of diabetes and prediabetes. The aim of the present study was to investigate the association between physical activity and blood glucose, as well as the influence of sex, menopause status and family history of diabetes.

MATERIALS AND METHODS

Participants with normal weight were selected from Risk Evaluation of Cancers in Chinese Diabetic Individuals: A Longitudinal Study, and divided into inactive (moderate-to-vigorous-intensity physical activity [MVPA] <30 min/week), low-degree (MVPA ≥30 and ≤420 min/week) and high-degree (MVPA >420 min/week) activity groups.

RESULTS

A total of 2,601 individuals with an average age of 57.85 ± 8.39 years were enrolled. Multivariate anova uncovered that after adjustment for sex and menopause status, and family history of diabetes, respectively, fasting plasma glucose, 2-h plasma glucose and glycated hemoglobin A1c decreased through inactive, low-degree and high-degree activity groups (all P for trend <0.05). The association of blood glucose indexes with physical activity was independent of this association with sex and menopause status, and first-degree family history of diabetes, respectively. Multivariate linear regression analyses showed that MVPA was an independent factor associated negatively with fasting plasma glucose, 2-h plasma glucose and glycated hemoglobin A1c, respectively (all P < 0.01).

CONCLUSIONS

A higher degree of physical activity was associated with lower blood glucose regardless of sex, menopause status and first-degree family history of diabetes. MVPA is a negative factor associated with blood glucose independently. Physical activity of adequate duration and intensity is strongly recommended to individuals with susceptibility to diabetes as a result of sex and family history, but without overweight/obesity.

Impact of gestational hypertension and preeclampsia on fetal gender: A large prospective cohort study in China

BACKGROUND

Recent studies suggested an association between fetal sex preponderance and hypertensive disorders during pregnancy, but the conclusions were inconsistent. Our objective was to investigate whether the occurrence of gestational hypertensive disorders would affect the possibility of delivering boys.

METHODS

Data were obtained from the China-US Collaborative Project for Neural Tube Defects Prevention, a large population-based cohort study. We included participants who were registered in 2 southern Chinese provinces, and whose information of blood pressure and sex delivery were recorded in detailed. Blood pressure was measured during pregnancy by trained health care workers and other health-related information was recorded prospectively. We used log-binomial regression to evaluate the association between gestational hypertension or preeclampsia and the chance of male delivery.

RESULTS

Among 205,605 singleton pregnancy women, the overall incidences of gestational hypertension and preeclampsia were 9.5% and 2.4%, respectively. The prevalence of male delivery was 51.1% and 50.2% in the groups of gestational hypertension and preeclampsia, while in the normotension group was 52.0%. After adjustment for the effects of the main potential confounders, women with gestational hypertension and preeclampsia both showed significantly decreased probability of giving birth to a boy. The adjusted risk ratios (RRs) were 0.98 (95% confidence interval (CI): 0.97-0.99) and 0.96 (95% CI: 0.94-0.99), respectively.

CONCLUSIONS

Our results support a slight but significant association between gestational hypertension or preeclampsia and decreased likelihood of male delivery.

Long-term trends in smoking prevalence and its socioeconomic inequalities in Korea, 1992-2016

BACKGROUND

The aim of this study was to investigate long-term trends in smoking prevalence and its socioeconomic inequalities in Korea.

METHODS

Data were collected from 10 rounds of the Social Survey of Statistics Korea between 1992 and 2016. A total of 524,866 men and women aged 19 or over were analyzed. Age-adjusted smoking prevalence was calculated according to three major socioeconomic position indicators: education, occupational class, and income. The prevalence difference, prevalence ratio, slope index of inequality (SII), and relative index of inequality (RII) were calculated to examine the magnitude of inequality in smoking.

RESULTS

Smoking prevalence among men decreased from 71.7% in 1992 to 39.7% in 2016, while smoking prevalence among women decreased from 6.5% in 1992 to 3.3% in 2016. Socioeconomic inequalities in smoking prevalence according to the three socioeconomic position indicators were found in both men and women throughout the study period. In general, absolute and relative socioeconomic inequalities in smoking, measured by prevalence difference and prevalence ratio for education and occupational class, widened during the study period among Korean men and women. In men, the SII for income increased from 7.6% in 1999 to 10.8% in 2016 and the RII for income also increased from 1.11 in 1999 to 1.31 in 2016. In women, the SII for income increased from 0.1% in 1999 to 2.4% in 2016 and the RII for income increased from 1.39 in 1999 to 2.25 in 2016.

CONCLUSION

Pro-rich socioeconomic inequalities in smoking prevalence were found in men and women. Socioeconomic inequalities in smoking have increased in parallel with the implementation of tobacco control policies. Tobacco control policies should be developed to decrease socioeconomic inequalities in cigarette use in Korea.

Association Between Serum Cotinine Level and Serological Markers of Epstein-Barr Virus in Healthy Subjects in South China Where Nasopharyngeal Carcinoma Is Endemic

Introduction: Self-reported smoking has been associated with higher seropositivity for the IgA response to Epstein–Barr virus (EBV) viral capsid antigen (VCA-IgA) and transcription activator protein (Zta) in healthy men in southern China where nasopharyngeal carcinoma (NPC) is endemic. Results on the association of biochemically verified smoking status with EBV reactivation are scarce. We aimed to investigate the relations of serum cotinine level with serological markers of EBV in healthy women, in addition to men.

Methods: We collected information on demographic, lifestyle, environmental factors, and EBV serological markers in a cross-sectional study on 2,275 healthy subjects who were recruited from physical examination centers in Guangdong Province, China. In the present analysis, 901 subjects' serum cotinine levels have been measured by enzyme-linked immunosorbent assay (ELISA). Odds ratios (seropositivity of four EBV serological markers vs. seronegativity) for categorical serum cotinine levels were calculated by unconditional logistic regression with a group-specific confidence interval (CI).

Results: In women, compared with lower serum cotinine level (0–0.71 ng/ml), higher cotinine level (>0.71–1.20 ng/ml; >1.20–228.40 ng/ml) was associated but non-significantly with higher seropositivity for EBV VCA-IgA (age- and education-adjusted OR = 1.18, 95% CIs = 0.84–1.64, 1.06, 0.75–1.50). These associations remained but still non-significant after adjusting for 5-year age group, education, family history of cancer, consumption of tea, Chinese herbal tea, salted fish at childhood, and exposure to occupational dust, chemical, fume, and radiation (multivariable adjusted OR = 1.21, 95% CIs = 0.85–1.71, 1.09, 0.76–1.55). In men, compared with lower serum cotinine level (0–2.15 ng/ml), higher cotinine level (>2.15–103.6 ng/ml; >103.6–419.4 ng/ml) was significantly associated with higher seropositivity for EBV VCA-IgA and Zta-IgA (age- and education-adjusted OR = 2.16, 95% CIs = 1.37–3.41, 1.79, 1.11–2.90; 1.98, 1.17–3.34, 1.95, 1.14–3.34). The association remained significant after adjusting for potential confounders for Zta-IgA (OR = 2.32, 95% CI = 1.37–3.93 for >2.15–103.6, and 2.50, 1.43–4.38 for >103.6–419.4 ng/ml), but not for VCA-IgA (2.06, 1.29–3.27, and 1.61, 0.96–2.71).

Conclusions: Higher serum cotinine level is associated with higher seropositivity for EBV serological markers in healthy men in southern China. Such positive association was also observed in women but became non-significant. If confirmed to be causal, this finding has important implications for tobacco control and prevention of EBV-related disease, particularly for NPC.

Prevalence and risk factors of chronic obstructive pulmonary disease in Anhui Province, China: a population-based survey

BACKGROUND

The prevalence of chronic obstructive pulmonary disease (COPD) in Anhui Province of eastern China remain uncertain. The present study provides the first estimate of the prevalence and risk factors of COPD in Anhui.

METHODS

A population-based survey was conducted in a representative sample of population aged 40 years or older in 2015. COPD was diagnosed based on 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.

RESULTS

A total of 2770 participants had reliable post-bronchodilator results and were included in the final analysis. The overall prevalence of COPD was 9.8% (95% CI: 8.2, 11.7). Prevalence was higher in men (14.8, 95% CI: 12.6, 17.2) than it was in women (5.2, 95% CI: 3.1, 8.7). Among adults with COPD, 45.0% (95% CI: 39.1, 51.0) had moderate or severe disease (GOLD stage II-IV), 0.7% (95% CI: 0.2, 2.9) reported that they had a previous pulmonary function test, and only 0.4% (95% CI: 0.1, 2.6) knew their diagnosis of COPD. Risk factors for COPD included older age (OR 1.06, 95% CI: 1.04, 1.08), male sex (OR 2.01, 95% CI: 1.22, 3.33), current smoking status (OR 2.63, 95% CI: 1.86, 3.73), primary school or lower education (OR 1.61, 95% CI: 1.12, 2.31), family history of lung disease (OR 1.50, 95% CI: 1.17, 1.93), and indoor exposure to coal for cooking or heating (OR 1.55, 95% CI: 1.11, 2.15). In addition, people in north region has a significantly higher risk for developing COPD than people in south region of Anhui (OR 1.98, 95% CI:1.44, 2.71).

CONCLUSIONS

COPD is prevalent in Anhui and the prevalence is highest in north region. Strategies aiming at prevention, early detection and treatment of COPD are urgently needed to reduce COPD-related burden.

Difference in Long-Term Trends in COPD Mortality between China and the U.S., 1992⁻2017: An Age⁻Period⁻Cohort Analysis

Complications due to chronic obstructive pulmonary disease (COPD) is a leading cause of death in China and the United States (U.S.). This study aimed to investigate the long-term trends in COPD mortality in China and the U.S. using data from the Global Burden of Disease Study 2017 (GBD 2017) and explore the age, period, and cohort effects independently by sex under the age-period-cohort (APC) framework. Taking the age group 40-44 years old, the period 1992-1996, and the birth cohort 1913-1917 as reference groups, we found that the age relative risks (RRs) of COPD mortality increased exponentially in both China and the U.S., the period RRs increased in the U.S. but decreased in China; and the cohort RRs showed an overall downward trend in both China and the U.S. with the year of birth. From 1992 to 2017, the increased RRs of COPD mortality in the U.S. was mainly attributable to the increased prevalence of smoking before 1965, while the decreased RRs of COPD mortality in China was mainly attributable to reduced air pollution as well as improvements in medical technology and more accessible health services. Reducing tobacco consumption may be the most effective and feasible way to prevent COPD in China. However, we also need to pay more attention to COPD in nonsmokers in the future.

Maternal periconceptional body mass index and risk for neural tube defects: results from a large cohort study in China

Background: Case-control studies have consistently suggested an association between pre- or periconceptional maternal obesity and an increased risk for neural tube defects (NTDs). Few studies have examined the association between body mass index (BMI) and NTDs using measured weight and height. We examined this association in a large cohort study in China.Methods: We used data from a large population-based cohort study established to evaluate the effectiveness of folic acid supplementation to prevent NTDs in China. BMI was computed using maternal weight and height measured before pregnancy or during early pregnancy. External birth defects were identified through a unique birth defects surveillance system. We estimated the birth prevalence and prevalence odds ratios (POR) for NTDs by Chinese BMI categories, controlling for potential confounders.Results: Our study population included a total of 194,844 women. We observed significantly elevated risk for spina bifida (adjusted POR = 5.4, 95% CI: 1.3-22.5) among children born to obese compared to normal weight women. Among women who took folic acid supplements, the adjusted POR for spina bifida among obese women was 10.0 (95% CI: 2.3-42.6) compared to pill users who were of normal weight. Borderline significantly elevated risk was observed for anencephaly (adjusted POR = 1.8; 95% CI: 1.0-3.2) among children born to underweight compared to normal weight women.Conclusions: Our findings suggest that maternal periconceptional obesity may be associated with an increased risk for spina bifida. Maternal underweight may be associated with increased risk for anencephaly.

Low serum osteocalcin levels are correlated with left ventricular systolic dysfunction and cardiac death in Chinese men

Osteocalcin is a newly identified type of cytokine secreted by osteoblasts, which has an endocrine function, mediates energy and glycol-lipid metabolism, and is closely related to cardiovascular diseases. In this study, we investigated the value of serum osteocalcin levels in predicting left ventricular systolic dysfunction and cardiac death. A total of 258 patients in the Department of Cardiology were included. Two-dimensional echocardiography was performed in all the subjects. The cardiac death of subjects occurring with a median follow-up of 4.6 years was informed via phone calls or the electronic medical records. The serum osteocalcin levels were measured using electrochemiluminescent immunoassay. We found that the median left ventricular ejection fractions (LVEFs) were 62% in men and 63% in women. In the men with a LVEF > 62%, the serum osteocalcin levels were significantly higher than in those with LVEF ≤ 62% (P = 0.042), whereas this difference was absent in the women. Both the serum osteocalcin (β = 0.095, P = 0.028) and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP; β = -0.003, P < 0.01) levels remained independently significantly correlated with LVEF in the men but not in the women. Receiver operating characteristic (ROC) analyses of the men revealed that the serum osteocalcin (P = 0.007), serum NT-pro-BNP (P = 0.018) and serum osteocalcin + NT-pro-BNP (P < 0.01) levels were all significant in identifying left ventricular systolic dysfunction at baseline, but the pairwise comparisons of the three areas under the curves (AUCs) were all non-significant. The men in the lower osteocalcin level group at baseline suffered a greater risk of future cardiac death than those in the higher osteocalcin level group, whereas the result for NT-pro-BNP exhibited the opposite pattern. In conclusion, lower serum osteocalcin levels in the men could identify left ventricular systolic dysfunction and cardiac death in a manner that was not inferior to high serum NT-pro-BNP levels.

Prevalence of Smoking and Knowledge About the Hazards of Smoking Among 170 000 Chinese Adults, 2013–2014

Introduction

Periodic population surveys of smoking behavior can inform development of effective tobacco control strategies. We investigated smoking patterns, cessation, and knowledge about smoking hazards in China.

Methods

A nationally representative cross-sectional survey recruited 176 318 people aged ≥18 years across 31 provinces of China in 2013–2014, using multi-stage stratified cluster sampling methods. The smoking patterns, cessation, and knowledge about smoking hazards were analyzed, overall and in population subgroups, adjusting for sample selection weight and post-stratification factors.

Results

Among men, 60.7% were ever-smokers, with proportions of regular, occasional and former smokers being 46.3%, 5.5%, and 8.8% respectively. Among women, only 2.8% had ever smoked. The prevalence of ever smoking in men was higher in rural than urban areas (63.2% vs. 57.6%) and varied from 39.5% to 67.4% across 31 provinces. Among male regular smokers, the mean daily number of cigarettes smoked was 17.8, with mean age at first starting to smoke daily being 20.1 years. Among current smokers, one-third (32.6% men, 32.1% women) had tried to quit before and 36.8% (36.8% men, 35.5% women) intended to quit in the future. Of the Chinese adults, 75.9% recognized that smoking was hazardous, with the proportions believing that smoking could cause lung cancer, heart attack or stroke being 67.0%, 33.2%, and 29.5%, respectively and with 26.0% reporting that smoking could cause all these conditions.

Conclusion

Among Chinese adults, the smoking prevalence remained high in men but was low in women. In both men and women, knowledge about smoking hazards was poor.

Implications

This study showed that tobacco smoking remained highly prevalent among adult men in China in 2013–2014. Moreover, men born in recent decades were more likely to start smoking at younger ages and to smoke more cigarettes than those born in previous generations. There was a large regional variation in male smoking prevalence, with the least economically developed regions having higher prevalence. In contrast, few women in China smoked, especially among those born in recent decades. The contrasting smoking patterns in men and women is likely to result in an increasingly large gender disparity in life expectancy in the coming decades.

Correlated Factors with Quitting Attempts Among Male Smokers in Vietnam: A QUITLINE-Based Survey

Despite its decreasing prevalence, cigarette smoking remains the second leading cause of preventable death worldwide. In Vietnam, despite recent smoking cessation efforts, the prevalence of tobacco consumption remains high, particularly among males. In this study, we aim to evaluate the self-efficacy in quitting smoking (i.e., quitting confidence), intention to quit, and identifying associated factors among both rural and urban Vietnamese male populations. A cross-sectional study was conducted on 321 patients (52.7% urban and 47.4% rural inhabitants) who utilized QUITLINE services of Bach Mai Hospital (Hanoi, Vietnam). Socio-economic status, smoking history, cigarette usage data, and intent to quit were assessed. Baseline data were correlated with quitting confidence, to identify significant associated factors. The majority (75.9%) of participants were in the planning phase of cessation, yet 90.8% lacked complete confidence in their quitting ability. Older age, fewer cigarettes per day and previous quitting attempts were associated with quitting confidence (p < 0.05) and plans to quit (p < 0.05). Older smokers and previous quitters were more confident in their ability to quit in the near future and more likely to have made plans to quit. Future smoking cessation efforts should focus on improving self-efficacy, particularly among younger and newer smokers.

Socioeconomic and lifestyle factors associated with HPV infection in pregnant women: a matched case-control study in Beijing, China

Background

Human papillomavirus (HPV) infection plays key role in the development of cervical cancer. The purpose of this study was to investigate socioeconomic and lifestyle factors associated with HPV infection in pregnant women in Beijing, China.

Methods

An age matched case-control study designed with 66 women as the case group (HPV positive) and 132 women as the control group (HPV negative) was carried out in two hospitals in Beijing. Socioeconomic and lifestyle factors were obtained using a standard questionnaire. Cervical cells from study subjects were collected for HPV detection. An unconditional logistic regression model with backward stepwise selection was performed to predict the odds ratio (OR) and 95% confidence interval (CI) for the significant factors associated with HPV infection.

Results

The analyses of present data show that alcohol consumption during pregnancy was the strongest significant factor (OR = 3.35, 95% CI = 1.40–8.03, p = 0.007) when comparing the case (HPV positive) group with the control (HPV negative) group. There were no statistical differences observed in any of the socioeconomic factors when comparing the case and control groups.

Conclusion

The results of this study may help to prevent HPV infection in China by providing evidence to support improving the national policy on alcohol restriction and introducing public health interventions, especially for pregnant women in Beijing.

Migration Status and Smoking Behaviors in Later-Life in China-Evidence From the China Health and Retirement Longitudinal Study (CHARLS)

Background: China is the biggest consumer of tobacco in the world, with a high prevalence of smoking especially among men. Along with the rapid demographic change in China, the burden of diseases attributable to health behaviors, particularly smoking is steadily increasing. So, smoking has become a major risk factor for mortality in China. Smoking behaviors may be related to migration processes, as a result of both who migrates and post-migration experiences related to socioeconomic position, stress and acculturation. Existing studies that have examined smoking and migration in China have, however, only focused on temporary rural-to-urban migrants and focused on relatively younger migrants. This paper examines the association between smoking behaviors and a comprehensive assessment of migration status in later-life in China.

Methods: Using the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative dataset, this paper studies smoking behaviors of rural-to-urban migrants, urban-to-urban migrants, rural return migrants, and urban return migrants. We compare them with corresponding non-migrant groups in both rural and urban locations in China. Using a model that controls for demographic factors, early-life circumstances, socioeconomic factors, and factors related to migration, we examine both the decision to start smoking and the decision to quit smoking. In addition, we also address pre-migration selection in our analyses.

Results: The results show rural-to-urban migrants are no more likely to start smoking compared with rural non-migrants, but they are more likely to quit smoking. While urban-to-urban migrants are more likely to start smoking compared with urban non-migrants, this effect is explained by the factors we include in the full model. Urban-to-urban migrants are, however, less likely to quit smoking. Moreover, both rural return migrants and urban return migrants seem to be more likely to start smoking and less likely to quit smoking compared with non-migrant groups.

Conclusion: There are strong associations between migration status and later-life smoking behaviors in China; these associations vary greatly according to different migration status and point to populations and factors that public health activities should focus on.

Metabolic, inflammatory, and oxidative stress markers in women exposed to secondhand smoke

Background

Secondhand smoke (SHS) exposure has adverse effects on the cardiovascular system. This study aimed to determine the effects of SHS on the cardiovascular disease biomarkers, namely the metabolic, inflammatory, and oxidative stress markers in healthy adult women.

Methods

This comparative cross-sectional study was conducted among healthy women. The cases included those women exposed to SHS, and the controls included those women not exposed to SHS. SHS exposure was defined as being exposed to SHS for at least 15 min for 2 days per week. Venous blood was taken to measure the metabolic markers (high molecular weight adiponectin, insulin level, insulin resistance, and nonesterified fatty acids), oxidative stress markers (oxidized low density lipoprotein cholesterol and 8-isoprostane), and inflammatory markers (high-sensitivity C-reactive protein and interleukin-6). A hair nicotine analysis was also performed. An analysis of covariance and a simple linear regression analysis were conducted.

Results

There were 101 women in the SHS exposure group and 91 women in the non-SHS exposure group. The mean (with standard deviation) of the hair nicotine levels was significantly higher in the SHS exposure group when compared to the non-SHS exposure group [0.22 (0.62) vs. 0.04 (0.11) ng/mg; P = 0.009]. No significant differences were observed in the high molecular weight adiponectin, insulin and insulin resistance, nonesterified fatty acids, 8-isoprostane, oxidized low density lipoprotein cholesterol, interleukin-6, and high-sensitivity C-reactive protein between the two groups. The serum high molecular weight adiponectin was negatively associated with the insulin level and insulin resistance in the women exposed to SHS. However, no significant relationships were seen between the high molecular weight adiponectin and nonesterified fatty acids, 8-isoprostane, oxidized low density lipoprotein cholesterol, high-sensitivity C-reactive protein in the SHS group.

Discussion

There were no significant differences in the metabolic, oxidative stress, and inflammatory markers between the SHS exposure and non-SHS exposure healthy women. A low serum level of high molecular weight adiponectin was associated with an increased insulin level and resistance in the women exposed to SHS.

Passive smoking and postpartum depression among Chinese women: A prospective cohort study in Tianjin, China

Smoking has been associated with depression in the general population. Whether passive smoking is also associated with postpartum depression (PPD) is uncertain. From 2010 to 2012, we recruited 8,842 pregnant women in Tianjin, China. The mainland Chinese version of the Edinburgh Postnatal Depression Scale was used to evaluate postpartum depressive symptoms after birth, with a score of >9 defining PPD. Data were collected using specially designed questionnaires or data from the electronic database of Tianjin Maternal and Child Health Information System. Odds ratios (OR) and 95 percent confidence intervals (CI) were obtained for the association of smoking status with PPD using binary logistic regression. Passive smoke exposure rates before and during pregnancy were 40.9 percent and 52.1 percent, respectively. A total of 8.5% (n = 747) of participants had PPD. Compared with those not exposed, women passively exposed to smoke before and during pregnancy had higher odds of PPD (before pregnancy: OR: 1.24, 95 percent CI: 1.03-1.50; during pregnancy: OR: 1.43, 95 percent CI: 1.16-1.77) after adjustment for confounding factors. Passive smoking before and during pregnancy were associated with PPD in Chinese women. Reducing passive smoke exposure may reduce PPD in Chinese women; further longitudinal studies are warranted to replicate these findings.

Effect of characteristics and life in cities in China on residents' smoking behaviour

Objective

This study aimed to identify the relationship between city-level economic development and smoking behaviour.

Methods

Using multilevel mixed-effects logistic methods, we examined the relationship between smoking/passive smoking and respondents’ lifestyles in the city.

Results

We found that respondents living in cities with higher per capita gross domestic product (GDP) were less likely to smoke than those living in cities with lower per capita GDP (odds ratio [OR] = 0.977, 95% confidence interval [CI]: 0.958–0.997). Further, respondents with higher levels of life satisfaction and subjective social status were less likely to smoke than those with lower levels of these variables (OR = 0.942, 95% CI: 0.893–0.994; OR = 0.955, 95% CI: 0.928–0.983, respectively). In terms of passive smoking, respondents with higher levels of subjective social status in their cities were less likely to smoke than those with lower levels (OR = 0.972, 95% CI: 0.948–0.996). Smoking and exposure to second-hand smoke were more common among those with lower socioeconomic status.

Conclusions

Smoking is one of the most serious public health hazards in China. People’s smoking behaviour is significantly related to characteristics of their cities and their socioeconomic status. Improved smoking-prevention measures are urgently required in China.

Prevalence and clustering of cardiovascular risk factors: a cross-sectional survey among Nanjing adults in China

OBJECTIVES

To estimate prevalence and clustering of cardiovascular risk factors (CRFs), and investigate the association between relevant characteristics and CRF clustering among adults in eastern China.

DESIGN

Community-based cross-sectional study.

SETTING

Data were collected by interview survey, physical measurements and laboratory examinations from the 2011 Nanjing Chronic Disease and Risk Factor Surveillance.

PARTICIPANTS

A representative sample of 41 072 residents aged ≥18 years volunteered to participate in the survey, with a response rate of 91.3%. We excluded 1232 subjects due to missing data or having a history of cardiovascular diseases; a total of 39 840 participants were included in the analysis.

OUTCOME MEASURES

Prevalence and clustering of five major CRFs including hypertension, diabetes, dyslipidaemia, overweight or obesity and current smoking.

RESULTS

Of 39 840 participants (mean age 47.9±16.2 years), 17 964 (45.1%) were men and 21 876 (54.9%) were women. The weighted prevalence of CRFs ranged between 6.2% for diabetes and 35.6% for overweight or obesity. The proportion of CRFs tended to be higher in men, the elderly, participants who lost a life partner, or lived in rural areas, or had lower level of education and total annual income. Overall, 30.1% and 35.2% of participants had one and at least two CRFs, respectively. Multivariate logistic regression revealed that men, older age, loss of a life partner, lower level of socioeconomic status, rural areas, insufficient physical activity or unhealthy diets were positively associated with CVD risk factor clustering, compared with their counterparts.

CONCLUSIONS

High regional prevalence of hypertension, dyslipidaemia, overweight or obesity and their clustering are present in Nanjing. The Nanjing government should develop effective public health policies at the regional level especially for high-risk groups, such as enhancing the public's health awareness, organising health promotion programmes, implementing smoke-free law, producing healthy nutrient foods, providing free or low-cost public sports and fitness facilities.

Socioeconomic, environmental and lifestyle factors associated with gestational diabetes mellitus: A matched case-control study in Beijing, China

Gestational diabetes mellitus (GDM) is a common health problem during pregnancy and its prevalence is increasing globally, especially in China. The aim of this study was to investigate socioeconomic, environmental and lifestyle factors associated with GDM in Chinese women. A matched pair case-control study was conducted with 276 GDM women and 276 non-GDM women in two hospitals in Beijing, China. Matched factors include age and pre-pregnancy body mass index (BMI). GDM subjects were defined based on the International Association of Diabetes Study Group criteria for GDM. A conditional logistic regression model with backward stepwise selection was performed to predict the odds ratio (OR) for associated factors of GDM. The analyses of data show that passive smoking at home (OR = 1.52, p = 0.027), passive smoking in the workplace (OR = 1.71, p = 0.01), and family history of diabetes in first degree relatives (OR = 3.07, p = 0.004), were significant factors associated with GDM in Chinese women. These findings may be utilized as suggestions to decrease the incidence of GDM in Chinese women by improving the national tobacco control policy and introducing public health interventions to focus on the social environment of pregnant women in China.

Invited Commentary: Secondhand Smoke-an Underrecognized Risk Factor for Cognitive Decline

Pan et al. (Am J Epidemiol. 2018;187(5):911-918) reported findings that exposure to secondhand smoke (SHS) was associated with cognitive decline over the course of 2 years among middle-aged and older Chinese women who never smoked, and they also reported a dose-response relationship. SHS exposure affects vulnerable people disproportionately because they have less control or choice over their living and working environment. Smoking is an established risk factor for dementia, but recent evidence reports on dementia-risk increase have not included SHS. Many epidemiologic studies collect data on smoking but not SHS exposure. SHS may be one of the most prevalent and modifiable risk factors for cognitive decline and therefore represents a major potential target for reduction of dementia risk. Given the high prevalence of smoking in China and other parts of the world, there is an urgent need to raise awareness of SHS reduction as part of global and national strategies to reduce cognitive decline and dementia and to introduce legislation that protects nonsmokers and vulnerable children and adults from SHS.

Seasonal variation of stroke incidence in Wujin, a city in southeast China

OBJECTIVE

This study aimed to evaluate seasonal variations in stroke incidence in a city in southeast China.

METHODS

First-ever stroke in residents aged 20 or older in Wujin city was reported by local physicians between January 2006 and December 2007. All reported stroke cases were checked with the city-wide health insurance system. Fatal cases were checked with the household registry system. The annualized stroke incidences were calculated for each month and each season. The stroke incidence was compared among seasons, with spring as a reference.

RESULTS

Wujin city had an adult (≥20 y old) population of 1 278 020 in 2010. A total of 2319 stroke cases, 1217 male and 1102 female, were reported in 2006 and 2007. The raw annual incidence of stroke was 90.7/100 000 (95% CI: 82.1-94.5). Stroke incidence was highest in September (125.2/100 000; 95% CI = 109.4-139.3) and lowest in January (78.8/100 000; 95% CI = 69.1-93.2). Stroke incidence was highest in autumn (OR = 1.18, 95% CI: 1.05-1.32, P < .001, compared with spring). Autumn also had the highest incidences of ischemic stroke (OR = 1.22, 95% CI: 1.06-1.40).

CONCLUSIONS

Stroke incidence showed monthly and seasonal variations in southeast China. Autumn had the highest incidences of both ischemic stroke and cerebral hemorrhage.

Longer time spent in bed attempting to sleep is associated with rapid renal function decline: the Dongfeng-Tongji cohort study

INTRODUCTION

Prospective evidence on the relation between time in bed and renal dysfunction remains limited. We aimed to investigate the association of time spent in bed attempting to sleep (TSBS) with renal function decline in a middle-aged and elderly Chinese population.

METHODS

About 16,733 eligible participants with a mean age of 62.3 years at baseline were included. Rapid renal function decline was defined as (baseline eGFR - revisit eGFR)/years of follow-up ≥5 mL/min per 1.73 m²/year. A total of 1738 study participants experienced rapid renal function decline after a median 4.6-year follow-up. Logistic regression models were used for multivariate analyses.

RESULTS

The adjusted odds ratio (OR) of rapid renal function decline was 1.18 (95% CI: 1.02, 1.37) for TSBS ≥9 h/night compared with TSBS 7 to <8 h/night. This association remained significant (OR = 1.19, 95% CI: 1.03, 1.38) after further adjustment for sleep quality, midday napping and usage of sleeping pills. Particularly, the association appeared to be prominent in individuals with diabetes.

CONCLUSIONS

Longer TSBS (≥9 h) was independently associated with an increased risk of rapid renal function decline. Our findings emphasized the importance to have optimal TSBS. Key messages Our study firstly investigated the association between time spent in bed attempting to sleep (TSBS) and renal dysfunction in Chinese adults. Compared with individuals TSBS 7 to <8 h, individuals with TSBS ≥9 h had 19% increased risk for rapid renal function decline after adjustment for multivariate confounders. The association appeared to be prominent in individuals with diabetes.

Serum FGF21 Is Associated with Future Cardiovascular Events in Patients with Coronary Artery Disease

Objectives: To investigate whether serum fibroblast growth factor 21 (FGF21) levels can be used to predict the future development of major adverse cardiovascular events (MACEs). Methods: This study included 253 patients who received subsequent follow-up, and complete data were collected for 234 patients. Independent predictors of MACEs were identified by using the Cox proportional-hazards regression analysis. The prognostic value of FGF21 levels for MACEs was evaluated by Kaplan-Meier survival analysis. Results: Of 229 patients finally enrolled in the analysis, 27/60 without coronary artery disease (CAD) at baseline experienced a MACE, and 132/169 patients with CAD at baseline experienced a MACE. Among patients with CAD at baseline, serum FGF21 levels were significantly higher in patients with MACEs (p < 0.05) than in patients without MACEs. Kaplan-Meier survival analysis showed patients with a higher serum FGF21 had a significantly lower event-free survival (p = 0.001) than those with a lower level. Further Cox proportional-hazards regression analysis, including the traditional risk factors for cardiovascular disease, showed that serum FGF21 was an independent predictor of MACE occurrence. Conclusions: In patients with CAD at baseline, an elevated serum FGF21 level was associated with the development of a MACE in the future.

Large-Scale Epidemiologic Studies of Cardiovascular Diseases in China: Need for Improved Data Collection, Methods, Transparency, and Documentation

With the advent of international precision medicine initiatives, it is important to evaluate existing large-scale studies to inform future investigation. This study sought to review, describe, and evaluate all large-scale cardiovascular disease (CVD) studies completed in China. We undertook a review of all large-scale CVD studies completed in China to describe and evaluate their design, implementation, and dissemination in published medical reports. Seventeen studies met the inclusion criteria. There were substantial variations in study design, geographic location, and data collection. Most studies lacked standard study names, did not publish their methods, and provided no publicly available data. Few studies included underdeveloped regions or minority groups. Most published articles contained only descriptions of the average population at risk of CVD, and no study predicted individual CVD risk or identified people at high risk. Future CVD studies in China may need to incorporate stronger systematic data collection methods, increased data transparency, clearer documentation, and standard study names to most gain from China's burgeoning field of CVD research.

Prevalence of active and passive tobacco smoking among Beijing residents in 2011

Objectives

This study was aimed to investigate the prevalence of active and passive tobacco smoking among Beijing residents in 2011.

Methods

A cross-sectional survey was conducted, using a stratified multistage cluster random sampling method to select a representative sample of 20,242, among Beijing residents aged 18–79 years. Active and passive tobacco smoking information was collected by a standardized and validated questionnaire in a face-to-face interview. All estimates of prevalence and numbers were weighted by the 2010 Beijing Population Census data and the sampling scheme.

Results

Among Beijing residents aged 18–79 years, the overall prevalence of ever smokers and current smokers were 33.13% and 30.18%, respectively. The prevalence in males was much higher than that in females (60.75% vs. 3.75% for ever smokers, and 55.53% vs. 3.21% for current smokers, respectively). For overall current smokers, 14.12 cigarettes were consumed per day. However, only 8.91% of ever smokers quitted smoking at the time of the survey, and 2.44% of ever smokers quitted smoking in recent two years. Furthermore, 44.74% of overall nonsmokers and former smokers, with 47.03% of males and 43.63% of females, reported exposure to secondhand smoke for at least 15 minutes per day and at least one day per week.

Conclusions

Tobacco smoking prevalence is still extremely high in Beijing. Nonsmokers do still suffer from secondhand smoke critically. Further urgent efforts for tobacco control are warranted in Beijing.

Lung cancer mortality clusters in Shandong Province, China: how do they change over 40 years?

Lung cancer has long been a major health problem in China. This study aimed to examine the temporal trend and spatial pattern of lung cancer mortality in Shandong Province from 1970 to 2013. Lung cancer mortality data were obtained from Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. A Purely Spatial Scan Statistics method with Discrete Poisson models was used to detect possible high-risk spatial clusters. The results show that lung cancer mortality rate in Shandong Province increased markedly from 1970-1974 (7.22 per 100,000 person-years) to 2011-2013 (56.37/100, 000). This increase was associated with both demographic and non-demographic factors. Several significant spatial clusters with high lung cancer mortality were identified. The most likely cluster was located in the northern region of Shandong Province during both 1970-1974 and 2011-2013. It appears the spatial pattern remained largely consistent over the last 40 years despite the absolute increase in the mortality rates. These findings will help develop intervention strategies to reduce lung cancer mortality in this large Chinese population.

Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics

This study aimed to evaluate the effects of psychological intervention and psychological plus drug intervention on smoking cessation among male smokers with single chronic diseases.A total of 509 male smokers were divided into psychological group (n = 290) and psychological plus drugs (n = 219) groups according to their will. The physicians provided free individual counseling and follow-up interviews with brief counseling for all the subjects. In addition to mental intervention, patients in psychological plus drug group also received bupropion hydrochloride or varenicline tartrate to quit smoking. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1-, 3-, and 6-month follow-up period. Data analyses were performed using intention-to-treat analysis and per protocol analysis.With regards to the 3 follow-up time points, 7-day point-prevalence abstinence rate in psychological plus drugs group was all higher than that in the psychological intervention group. Additionally, the 3-month continuous abstinence rate (21.4%) of the 6-month follow-up in the psychological group was not significantly higher than that (26.9%) in the psychological plus drugs group (P >.05 for all). Fagerström test score, stage of quitting smoking, perceived confidence or difficulty in quitting, and chronic disease types were independently correlated with 3-month continuous abstinence in the 6-month follow up (P <.05 for all). The results were similar between intentional analysis and protocol analysis.The psychological intervention and psychological plus drugs intervention exerted good effects on smoking cessation in a short time (1 month). Nevertheless, the advantages did not appear during long-time (6 months) follow-up.

Contribution of serum FGF21 level to the identification of left ventricular systolic dysfunction and cardiac death

AIM

The relationship between fibroblast growth factor 21 (FGF21) and cardiovascular disease has been well established in recent studies. This study aimed to investigate the relationship between FGF21 and left ventricular systolic dysfunction and cardiac death.

METHODS

Two-dimensional echocardiography was used to measure the left ventricular ejection fraction (LVEF) to estimate left ventricular systolic function. The optimal cutoff of FGF21 for identifying left ventricular systolic dysfunction at baseline was analyzed via receiver operating characteristic (ROC) curves. The identification of different serum levels of FGF21 and their association with cardiac death was analyzed via Kaplan-Meier survival curves. Serum FGF21 level was measured by an enzyme-linked immunosorbent assay kit, and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) level was determined by a chemiluminescent immunoassay.

RESULTS

A total of 253 patients were recruited for this study at baseline. Patients were excluded if they lacked echocardiography or laboratory measurement data, and there were 218 patients enrolled in the final analysis. The average age was 66.32 ± 10.10 years. The optimal cutoff values of FGF21 and NT-pro-BNP for identifying left ventricular systolic dysfunction at baseline were 321.5 pg/mL and 131.3 ng/L, respectively, determined separately via ROC analysis. The areas under the curves were non-significant among FGF21, NT-pro-BNP and FGF21 + NT-pro-BNP as determined by pairwise comparisons. Both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP were independent risk factors for left ventricular systolic dysfunction at baseline (odd ratio (OR) 3.138 [1.037-9.500], P = 0.043, OR 9.207 [2.036-41.643], P = 0.004, separately). Further Kaplan-Meier survival analysis indicated an association between both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP with cardiac death in 5 years [RR 5.000 (1.326-18.861), P = 0.026; RR 9.643 (2.596-35.825), P = 0.009, respectively].

CONCLUSIONS

Serum FGF21 level was significantly correlated with left ventricular systolic dysfunction at baseline. Patients with higher serum levels of FGF21 tended to suffer greater risks of cardiac death than patients with lower serum levels of FGF21. The identification of FGF21 and its relationship with left ventricular systolic function and cardiac death were non-inferior to NT-pro-BNP.

Impact of Periconceptional Folic Acid Supplementation on Low Birth Weight and Small-for-Gestational-Age Infants in China: A Large Prospective Cohort Study

OBJECTIVES

To explore the effects of maternal folic acid supplementation alone during pregnancy on the incidence of low birth weight (LBW) and small-for-gestational-age (SGA) infant status.

STUDY DESIGN

Data were derived from a large population-based cohort study performed in China to evaluate the prevention of neural tube defects with folic acid supplementation. The sample comprised 200 589 singleton live births registered in 2 southern Chinese provinces by mothers for whom detailed information on folic acid use was available. Gestational age was calculated from the first day of the last menstrual period. LBW was defined as a birth weight <2500 g. Infants were considered SGA when the age-adjusted birth weight was below the 10th percentile as defined by a national survey performed in 1998. Logistic regression was used to estimate the effects of folic acid after adjusting for the principal potential confounders.

RESULTS

The overall incidence of LBW and SGA status was 2.18% and 5.82%, respectively. The incidence of LBW and SGA status was 2.09% and 5.73% in women who took folic acid, and 2.27% and 5.90% in those who did not. The adjusted risk ratios associated with folic acid use were 0.85 (95% CI: 0.80-0.90) for LBW and 0.93 (95% CI: 0.89-0.96) for SGA status. Folic acid use during pregnancy appeared to be particularly important to prevent LBW and SGA status.

CONCLUSIONS

A maternal daily intake of 400 µg folic acid alone significantly reduced the risks of infant LBW and SGA status.

Understanding tobacco use and socioeconomic inequalities among men in Ghana, and Lesotho

Background

Tobacco use is one of the leading causes of preventable deaths and has become a significant public health issue. Previous studies have paid less attention to tobacco use and socio-economic equalities among men in developing countries. This study examines the relationship between tobacco use and socio-economic inequalities among men in Ghana and Lesotho.

Methods

The study made use of data from the 2014 Demographic and Health Survey (DHS) from Ghana, and Lesotho. Binary logistic regression was employed to examine the associations between socio-economic inequality characteristics of respondents and tobacco use.

Results

The results showed that the prevalence of tobacco use was high in Lesotho (47.9%) as compared to that of Ghana (6.3%). Tobacco use was generally high across all age groups in Lesotho and in contrast, it was relatively low across all ages in Ghana. A statistically significant association was found between all the socio-economic variables and tobacco use in both countries. The prevalence of tobacco use was smaller in age group 15–24 years compared to the age groups 25–34 years and 35–59 years in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR’s in Ghana are respectively 5.3 (95% CI: 3.29–8.59) and 9.7 (95% CI: 6.20–15.06), compared to respectively 1.7 (95% CI: 1.32–2.11) and 1.7 (95% CI: 1.36–2.12). Smoking prevalence was smaller in men with higher level of education compared to men with no education in both Ghana and Lesotho, although the association was weaker in Ghana. The AOR in Ghana is 0.1 (95% CI: (0.02–0.11), compared to 0.2 (95% Cl: (0.17–0.30). The prevalence of tobacco use was smaller among men in urban areas compared to rural areas in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 2.1 (95% CI: 1.67–2.73), compared to 1.6 (95% CI: (1.31–1.95). In both countries, prevalence of tobacco use was higher in men who are traditionalist/spiritualists or who had no religion compared to Christians, although the association was stronger in Ghana. The AOR in Ghana is 6.2 (95% CI: (4.42–4.09) compared to 1.7 (95% CI: (1.21–2.47). The prevalence of tobacco use was low among men with richest wealth status compared to men with poorest wealth status in both Ghana and Lesotho, although the association is weaker in Ghana. The AOR in Ghana is 0.1 (95% Cl: (0.06–0.17) compared to 0.4 (95% CI: (0.51–1.12). In relation to occupation, prevalence of tobacco use was smaller among professional workers compared to men in the Agricultural sector in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 9.3 (95% Cl: (4.54–18.99), compared to 3.5 (95% CI: (2.27–5.52). Formerly married men in both countries were more likely to use tobacco compared to currently not married men, although the prevalence was higher in Ghana. The AOR in Ghana is 1.6 (95% CI: (0.99–2.28)], compared to 1.4 (95% CI: (0.89–2.28) in Lesotho.

Conclusion

Although similar socio-economic inequality factors provided an understanding of tobacco use among men in Ghana and Lesotho, there were variations in relation to how each factor influences tobacco use.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-017-0197-5) contains supplementary material, which is available to authorized users.

Long-Term Effects of Famine on Chronic Diseases: Evidence from China's Great Leap Forward Famine

We evaluate the long-term effects of famine on chronic diseases using China's Great Leap Forward Famine as a natural experiment. Using a unique health survey, we explore the heterogeneity of famine intensity across regions and find strong evidence supporting both the adverse effect and the selection effect. The two offsetting effects co-exist and their magnitudes vary in different age cohorts at the onset of famine. The selection effect is dominant among the prenatal/infant famine-exposed cohort, while the adverse effect appears dominant among the childhood/puberty famine-exposed cohort. The net famine effects are more salient in rural residents and non-migrants subsamples. Gender differences are also found, and are sensitive to smoking and drinking behaviors. Our conclusion is robust to various specifications. Copyright © 2016 John Wiley & Sons, Ltd.

Trends in Cigarette Smoking Among Older Male Adults in China: An Urban-Rural Comparison

This study compared urban/rural trends in cigarette smoking rates among older male adults in China. Data were derived from the China Health and Nutrition Survey ( N = 5,147). Logistic models were computed to assess the occurrence of cigarette smoking between 1991 and 2011 across urban/rural administrative districts. Cigarette smoking rates remained consistent (about 50%) in rural villages over the last two decades but decreased by about 1.1 percentage points annually in urban neighborhoods. After adjusting for individual and community characteristics, divergent urban/rural trends in cigarette smoking rates did not vary statistically. Trends in cigarette smoking may be associated with unbalanced social and economic development in urban and rural China, and are an indicator of social determinants of health inequalities. Results suggest tobacco control policies and interventions should specifically focus on older adults vulnerable to economic inequality. Findings have implications for health and economic inequality among older adults in general.

Trends in socioeconomic inequalities in five major risk factors for cardiovascular disease in the Korean population: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2001-2014

OBJECTIVES

To examine trends in socioeconomic inequalities in major cardiovascular disease (CVD) risk factors among the Korean population.

DESIGN

Cross-sectional study.

SETTING

A nationally representative population survey database.

PARTICIPANTS

A total of 42 725 Koreans, aged 25-64 years, who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) II (2001) to VI (2013-2014).

MAIN OUTCOME MEASURES

Trends in socioeconomic inequalities in five major CVD risk factors (smoking, obesity, diabetes, hypertension and hypercholesterolaemia).

RESULTS

Gender differences were noted in the time trends in socioeconomic inequalities in smoking, obesity, diabetes and hypertension. Among men, low socioeconomic status (SES) was associated with higher prevalence of smoking, but not with obesity, diabetes or hypertension. The magnitudes of socioeconomic inequalities in smoking, obesity and diabetes remained unchanged, and the magnitude of the inequality in hypertension decreased over time. However, among women, low SES was associated with higher prevalence of smoking, obesity, diabetes and hypertension. Time trends towards increasing socioeconomic inequalities, measured by income, in smoking, obesity and diabetes were found in women. Unlike the other CVD risk factors, hypercholesterolaemia was not associated with socioeconomic inequality.

CONCLUSIONS

SES had a stronger impact on major CVD risk factors among Korean women than men. Moreover, socioeconomic inequalities in smoking, obesity and diabetes worsened among Korean women over time. Public policies to prevent smoking, obesity and diabetes in women with lower SES are needed to address inequalities.

The burden of lung cancer mortality attributable to fine particles in China

Although studies have examined the associations between fine particles (PM_2.5) and lung cancer mortality in US and European countries, the evidence is still limited for China. In addition, no study has provided estimates of spatial variation in lung cancer mortality attributable to PM_2.5 in China. In this study, we quantified the associations between lung cancer mortality and PM_2.5, using a spatiotemporal model with observed data of lung cancer mortality from 75 communities from the National Cancer Registration of China from 1990 to 2009 and the annual concentrations of PM_2.5 at 0.5°×0.5° spatial resolution. We also estimated lung cancer mortality burden attributable to PM_2.5 in China, with predicted county level lung cancer deaths in 2005. We found that the PM_2.5-lung cancer mortality associations were non-linear, with thresholds of 40μg/m³ overall, 45μg/m³ for male, 42μg/m³ for female, 45μg/m³ for those aged 30-64years, 48μg/m³ for those aged 65-74years, and 40μg/m³ for those aged 75years and more, above which the relative risks were 1.08 (95% CI: 1.07, 1.09), 1.07 (95% CI: 1.05, 1.08), 1.12 (95% CI: 1.1, 1.14), 1.05 (95% CI: 1.04, 1.07), 1.07 (95% CI: 1.06, 1.09), and 1.14 (95% CI: 1.12, 1.16) respectively. There were 51,219 (95% CI: 45,745-56,512) lung cancer deaths attributed to PM_2.5 in 2005, with attributable fractions of 13.7% (95% CI: 12.23-15.11%) overall, 10.01% (95% CI: 8.37-11.58%) for men, 18.06% (95% CI: 15.81-20.18%) for women, 8.35% (95% CI: 6.07-10.51%) for those aged 65-74years, 9.73% (95% CI: 7.6-11.75%) for those aged 65-74years, 21.7% (95% CI: 19.27-23.99%) for those aged 75years or more. In conclusion, assuming a causal relation a reduction in exposure levels of PM_2.5 below thresholds would avert a substantial number of deaths from lung cancer in China.