The case for semi-mandatory HPV vaccination in China

HPV Vaccination Behavior, Vaccine Preference, and Health Beliefs in Chinese Female Health Care Workers: A Nationwide Cross-Sectional Study

Human papillomavirus (HPV) vaccination has been proven to be the most effective method to prevent cervical cancer. This study aimed to determine the HPV vaccination behavior and preference in Chinese female health care workers. A nationwide cross-sectional study was performed to recruit 15,967 respondents aged 18-45 years from 31 provinces in China's mainland in 2021. Of them, 30.0% have been vaccinated or have made an appointment. Regardless of actual vaccination status, respondents mostly preferred the 9-valent HPV vaccine (58.6%), followed by 4-valent (15.6%) and 2-valent vaccines (3.1%); additionally, 17.9% did not have a preference. Moreover, health beliefs on HPV and HPV vaccination were measured using a health belief model (HBM) analysis. Six HBM constructs differed significantly by HPV vaccination status. Higher levels of perceived susceptibility (beta = 0.074), perceived benefit (beta = 0.072), self-efficacy (beta = 0.304), and cues to action (beta = 0.039) scales were significantly associated with increasing HPV vaccine uptake. In contrast, perceived severity (beta = -0.019) and perceived barriers (beta = -0.089) were negative factors. In conclusion, HPV vaccine uptake is high in Chinese female health care workers. HBM constructs may be effective in facilitating the improvement and delivery of targeted intervention programs to increase HPV vaccine uptake.

Willingness to human papillomavirus (HPV) vaccination and influencing factors among male and female university students in China

This study compared the willingness to receive human papillomavirus (HPV) vaccination and the influencing factors between male and female university students who had never been vaccinated against HPV in China. University students were recruited from seven universities in China. A self-administered questionnaire was used to collect information about demographic characteristics, willingness to HPV vaccination, and possible influencing factors including demographics, knowledge, and attitude toward HPV vaccination. The χ2 test was used to test the difference between males and females' knowledge and attitudes to HPV vaccination. Multivariate logistic regression was employed to detect the factors associated with willingness to HPV vaccination. A total of 7335 university students participated in the survey (3570 males and 3765 females). Over 70% of the participants had previously received sex education and knowledge. The average age of sexual debut was 17.5 years old. More male students reported acceptance of premarital sex than female students did (χ2  = 708.458, p < 0.001). Female students had better knowledge and attitudes to HPV in general, while male students perceived a higher chance of being infected by HPV compared with female students (χ2  = 6.047, p =  0.014). The level of knowledge (male: adjusted odds ratio [AOR] = 1.935, 95% confidence interval [CI]:1.516-2.470; female: AOR = 1.227, 95% CI: 1.055-1.428) and receiving sex education (male: AOR = 1.414, 95% CI: 1.109-1.804; female: AOR = 1.289, 95% CI: 1.064-1.562) were indicators of the HPV vaccination willingness for both genders. For male students, those who had ever inoculated optional self-paid vaccines were more likely to receive the HPV vaccine than those who had not (AOR = 1.567, 95% CI: 1.242-1.977). Female students were more willing to be vaccinated against HPV, if they had higher living expenses (AOR = 1.395 and 3.717, 95% CI: 1.071-1.426 and 1.776-7.752), relatives or friends had certain cancer (AOR = 1.290, 95% CI: 1.095-1.518), ever had sexual experiences (AOR = 2.628, 95% CI: 1.788-3.863), and had ever consulted on HPV vaccination issues (AOR = 1.612, 95% CI: 1.367-1.901). In China, more active education should be provided to improve university students' knowledge and attitudes on HPV and HPV vaccination. Including HPV vaccine uptake for both males and females at recommended ages in National Immunization Program would be the most cost-effective way to prevent HPV infection.

HPV16 E6 gene polymorphisms and the functions of the mutation site in cervical cancer among Uygur ethnic and Han nationality women in Xinjiang, China

BACKGROUND

To investigate the genotype distribution of human papillomavirus (HPV) in infected Uygur and Han women in Xinjiang, China; analyze the HPV16 E6 gene polymorphism site and relationship with the development of cervical cancer.

METHODS

The HPV16 E6 sequence was analyzed using the European standard prototype to perform an evolutionary tree. HPV16 E6-T295/T350, G295/G350, and T295/G350 GV230 vectors were stably transfected into cervical cancer C33A cells to analyze the cell proliferation, migration and invasion, apoptosis by CCK8 and clonogenic assays, transwell and cell scratch assays, FACS experiments.

RESULTS

The total HPV infection rate was 26.390% (760/2879), whereas the Uygur 22.87% (196/857) and the Han was 27.89% (564/2022) (P < 0.05). Among 110 mutations, 65 cases of E6 genes were mutated at nucleotide 350 (T350G) with the leucine changing to valine (L83V). Moreover, there were 7 cases of E6 gene mutated at nucleotide 295 (T295G) with aspartic changing to glutamic (D64E). When E6 vector(s) of mutations sites were transfected into C33A cells, they were found to promote cellular proliferation, migration, invasion, and inhibit apoptosis. T295/G350-E6 was significantly stronger than G295/G350 and T295/T350, G295/G350 was significantly stronger than T295/T350 (P < 0.05). The T295/G350 had the strongest effect on C33A cells and G295/G350 was significantly stronger than T295/T350 (P < 0.05).

CONCLUSIONS

The positive HPV infection rates differed between the Uygur and Han in Xinjiang, China, and the genotype distribution of infection was different. After transfecting C33A cells with different eukaryotic expression vectors, the T295/G350 mutation site promoted the proliferation, migration, and invasion of C33A cells to a greater extent than G295/G350; however, G295/G350 had a stronger effect than T295/T350.

Zimet G, Alias H, Danaee M, Cai L, Zeng F, Wong LP. Human Papillomavirus (HPV) Vaccine Uptake and the Willingness to Receive the HPV Vaccination among Female College Students in China: A Multicenter Study

BACKGROUND

This study aimed to determine human papillomavirus (HPV) vaccine uptake and willingness to receive HPV vaccination among female college students, in China, and its associated factors.

METHODS

An online cross-sectional survey of female college students across the eastern, central, and western regions of China was undertaken between April and September 2019. Partial least squares structural equation modeling (PLS-SEM) was used to examine factors associated with the HPV vaccine uptake and willingness to receive the HPV vaccine.

RESULTS

Among the total 4220 students who participated in this study, 11.0% reported having been vaccinated against HPV. There are direct effects of indicators of higher socioeconomic status, older age (β = 0.084 and p = 0.006), and geographical region (residing in Eastern China, β = 0.033, and p = 0.024) on HPV vaccine uptake. Higher knowledge (β = 0.062 and p < 0.000) and perceived susceptibility (β = 0.043 and p = 0.002) were also predictors of HPV vaccine uptake. Of those who had not received the HPV vaccine, 53.5% expressed a willingness to do so. Likewise, social economic status indicators were associated with the willingness to receive the HPV vaccine. Total knowledge score (β = 0.138 and p < 0.001), both perceived susceptibility (β = 0.092 and p < 0.001) and perceived benefit (β = 0.088 and p < 0.001), and sexual experience (β = 0.041 and p = 0.007) had a positive and significant direct effect on the willingness to receive the HPV vaccine, while perceived barriers (β = -0.071 and p < 0.001) had a negative effect on the willingness to receive the HPV vaccine.

CONCLUSIONS

Geographical region and socioeconomic disparities in the HPV vaccination uptake rate and willingness to receive the HPV vaccine provide valuable information for public health planning that aims to improve vaccination rates in underserved areas in China. The influence of knowledge and perceptions of HPV vaccination suggests the importance of communication for HPV immunization.

Prevalence, Awareness, Treatment, and Control and Related Factors of Hypertension in Multiethnic Agriculture, Stock-Raising, and Urban Xinjiang, Northwest China: A Cross-Sectional Screening for 47000 Adults

Background

Hypertension is the leading cause of cardiovascular disease. Distribution of hypertension and related factors among multiethnic population in Northwest China remains scarce. The aim was to determine prevalence, awareness, treatment, control, and risk factors associated with hypertension among multiethnic population in Northwest China.

Methods

We conducted a blood pressure (BP) screening project covering a third of adults in Emin Xinjiang, Northwest China, during 2014–2016. Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, and/or taking antihypertension drugs. We compared prevalence, awareness, treatment, and control of hypertension and related factors by different regions (agriculture, stock-raising, or urban) and by ethnic groups.

Results

Totally 47,040 adults were screened with 48.5% women. Overall prevalence, awareness, treatment, and control of hypertension were 26.5%, 64.6%, 44.5%, and 15.3%, respectively. Age-gender-adjusted hypertension prevalence was higher in urban (28.2%) than in other regions and in Kazakh (30.3%) than in others. The lowest awareness and treatment rates were observed in the agricultural region and in Kazakh subjects, while the lowest control was in the stock-raising region (13.8%) and in Kazakh subjects (12.6%). After adjusting for age, gender, ethnicity, and regions, compared to normal weight, nonsmokers, and nondrinkers, obesity, smoking, and alcohol intake were significantly related to increased prevalence of hypertension by 94%, 1.5, and 3.9 folds, respectively.

Conclusions

Disparities in hypertension control among regions and ethnic groups suggested inadequate screening and treatment, especially in stock-raising regions and Kazakh populations. Control of alcohol intake, smoking, and obesity should be at high priority of health promotion.

The feasibility of universal HPV vaccination program in Shenzhen of China: a health policy analysis

Background

HPV vaccination for the prioritized adolescent girls is well accepted and implemented in developed countries as an effective measure for cervical cancer prevention and control with increasing population-level effectiveness evidence accumulated. This study is to assess the feasibility of universal HPV vaccination among adolescent girls to inform strategies to manage political dimensions of policy-making process in Shenzhen, China, offering insights for other low- and middle-income countries undergoing HPV vaccine introduction.

Methods

Document review and in-depth interviews with identified stakeholders were conducted. The framework of Health Policy Triangle was adapted to guide data collection and analysis in terms of context, actors, process and content. Stakeholder analysis examining actors’ position, power, role and interest and thematic analysis focusing on data coding and theme development were used.

Results

Shenzhen’s contextual factors include legislative authority under a unitary political system, economic developments and cultural values on immunization and sexuality. Stakeholders’ position and power could be explained by their role and interest in the Top-down health administration. Mothers could be potential bystanders if having little knowledge on HPV vaccination. Themes in policy-making process were problem definition, advocacy activities to promote HPV vaccination, HPV vaccine demand and access, the role of media and political attention on evidence-informed policy-making in Shenzhen. These stakeholders also discussed different aspects of program planning prospectively.

Conclusions

Shenzhen witnesses a possibility of demonstration projects for local government’s horizontal accountability but no potential advocates were identified at local level for fragmented organization of public health facilities and health professionals’ lacking mobilization skills. A cervical cancer prevention expert could be a policy entrepreneur. Despite of these challenges, the recommendations to enhance the feasibility include multi-participation to engage non-governmental organizations, pharmaceuticals, target girls and their mothers, power enforcement along governing system, as well as better use of the media.

Screening for HPV infection in exfoliated cervical cells of women from different ethnic groups in Yili, Xinjiang, China

We investigated the infection status and genotype distribution of human papillomavirus (HPV) in women of different ages and various ethnic groups in the Yili region, Xinjiang, China. We checked the HPV genotypes of 3,445 samples of exfoliated cervical cells using the PCR–reverse dot blot method. The total infection rate of HPV was 25.60% (882/3,445). The ethnic stratification showed that the infection rates were 22.87% (196/857) in Uygur, 21.55% (122/566) in Kazak, and 27.89% (564/2,022) in Han individuals. The most prevalent high-risk genotypes were HPV16, HPV52, and HPV53 in Uygur and Kazak and HPV16, HPV52, and HPV58 in Han ethnic groups. The age stratification showed that the infection rates in Han, Uygur, and Kazak women were up to 40.9% (61/149) in those aged 26–30 years, 41.5% (22/53) in those over 61 years old, and 30.2% (29/96) in those 46–50 years old, respectively. Therefore, HPV infection and HPV genotype distribution varied among the different age groups of the three ethnic groups.

The Optimal Ethnic-Specific Waist-Circumference Cut-Off Points of Metabolic Syndrome among Low-Income Rural Uyghur Adults in Far Western China and Implications in Preventive Public Health

Background: Metabolic syndrome is pandemic; however, the cut-off values for waist circumference (WC) vary widely depending on the ethnic groups studied and the criteria applied for WC measurement. Previous studies for defining optimal WC cut-off points included high-income and urban settings, and did not cover low-income, rural settings, especially for ethnic minorities. This study aimed at defining optimal ethnic-specific WC cut-off points in a low-income, rural population comprising the largest inhabitant minority group residing in far Western China. Methods: Questionnaire-based surveys, physical examinations, and blood testing of 3542 individuals were conducted in 2010, using a stratified cluster random sampling method in rural Uyghur residents (≥18 years old) from 12 villages in Xinjiang, China, approximately 4407 km away from the capital city, Beijing. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. Optimal, ethnic-specific WC cut-off values for diagnosing metabolic syndrome were determined using receiver operator characteristic (ROC) curve analysis. Results: As WC increased, there was a significant, increasing trend of detection and risk in rural Uyghur adults, regardless of the presence of ≥1 or ≥2 components of metabolic syndrome by IDF criteria. The optimal ethnic-specific WC cut-off point to predict the presence of metabolic syndrome was 85 cm for men and 82 cm for women. With these cut-off points, the prevalence rates of metabolic syndrome among men, women, and overall population in Uyghur adults were 19.5%, 23.0%, and 21.3%, respectively. Conclusions: We report a high prevalence of metabolic syndrome, especially in women, among rural Uyghurs in Western China. A WC cut-off of 85 cm in men and 82 cm in women was the best predictor of metabolic syndrome in this population. Because of the cost-effectiveness in measuring WC, we recommend that these WC cut-off points be integrated into local preventive policies for public health as the primary screening criteria for metabolic syndrome and related diseases among low-income, rural minorities.

Prevalence of Hypertension among Adults in Remote Rural Areas of Xinjiang, China

OBJECTIVE

The present study aimed to estimate prevalence of hypertension among adults in rural remote areas of Xinjiang, China and evaluate the associated factors of hypertension.

METHODS

The survey was based on questionnaire interviews and clinical measurements of 11,340 individuals (≥18 years old), and was conducted during 2009-2010 via a stratified cluster random sampling method in the remote rural areas of Xinjiang, about 4407 km away from the capital Beijing. Hypertension was defined according to WHO/ISH criteria.

RESULTS

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the population were (126.3 ± 21.4) and (80.9 ± 13.4) mmHg. Compared with Han nationality subjects, SBP and DBP of Kazakh nationality subjects were significantly high (p < 0.05), while the SBP and DBP of Uyghur subjects were significantly low (Kazakh: (128.7 ± 23.9) and (83.0 ± 14.6) mmHg, Uyghur: (123.6 ± 19.3) and (77.4 ± 12.7) mmHg, Han: (126.5 ± 20.5) and (82.6 ± 11.9) mmHg, p < 0.05). Prevalence of hypertension of the population was 32.1%, and was greater among Kazakhs and lower among Uyghur than Han (Kazakh: 36.9%, Uyghur: 26.1%, Han: 33.7%, p < 0.05). The age-standardized prevalence of hypertension was 30.2%, and was greater among Kazakhs while lower among Uyghurs than Han subjects (Kazakh: 37.0%, Uyghur: 26.0%, Han: 33.8%, p < 0.05, p < 0.05). Multivariate logistic regression analyses showed Gender (OR = 1.324), age (OR = 2.098, 3.681, 6.794, 9.473, 14.646), nationality (OR = 1.541), occupation (OR = 1.659, 1.576), education (OR = 1.260), BMI (OR = 1.842), WC (OR = 1.585), WHR (OR = 1.188), WHR (OR = 1.188), diabetes (OR = 1.879), hypertriglyceridemia (OR = 1.361), hypercholesterolemia (OR = 1.131) and high blood low density lipoprotein cholesterol (LDL-C) (OR = 1.956) were all positively correlated with hypertension, while low blood high density lipoprotein cholesterol (HDL-C) (OR = 0.765) was negatively correlated with hypertension.

CONCLUSIONS

Prevalence of hypertension among adults in remote rural areas of Xinjiang was higher than the national average. Prevalence of hypertension was greater among Kazakhs and lower among Uyghurs than Han nationals, thus indicating significant differences between regions and nationalities. Gender, age, nation, occupation, education, overweight or obesity, abdominal obesity, diabetes, hyperlipidemia, hypercholesterolemia, high LDL-C were positively correlated with hypertension, low HDL-C was negatively correlated with hypertension.

Association between Eight Functional Polymorphisms and Haplotypes in the Cholesterol Ester Transfer Protein (CETP) Gene and Dyslipidemia in National Minority Adults in the Far West Region of China

We have investigated the relationship between the polymorphisms and haplotypes in the CETP gene, and dyslipidemia among the Xinjiang Kazak and Uyghur populations in China. A total of 712 patients with dyslipidemia and 764 control subjects of CETP gene polymorphism at rs12149545, rs3764261, rs1800775, rs711752, rs708272, rs289714, rs5882, and rs1801706 loci were studied by the Snapshot method, linkage disequilibrium analysis and haplotype construction. The results are as follows: (1) the minor allele of eight loci of frequencies in the two groups were different from other results of similar studies in other countries; (2) In the linear regression analysis, the HDL-C levels of rs708272 TT, rs1800775 AA, rs289714 CC and rs711752 AA genotypes were significantly higher than those of other genotypes, however, the rs3764261 GG and rs12149545 GG genotypes were significantly lower than those of other genotypes in the two ethnic groups. The HDL-C levels of the rs12149545 GG genotype were lower than those of other genotypes; (3) in the control group, the rs708272 CT genotype of TG levels were lower than in the CC genotype, the T genotype of LDL-C levels were lower than in the CC genotype, and the HDL-C levels were higher than in the CT genotype; the rs1800775 AC genotype of TG levels were higher than in the AA genotype, the rs711752 AG genotype of TG levels were lower than in the GG genotype, the AA genotype LDL-C levels were lower than in the GG genotype, and the HDL-C levels were higher than in the AG genotype; the rs1800775 AC genotype of TG levels were higher than in the AA genotype. In the dyslipidemia group, the rs708272 TT genotype of TC and LDL-C levels were higher than in the CT genotype and the rs3764261 TT genotype of TC levels were higher than in the GG genotype. The rs711752 AA genotype of TC and LDL-C levels were higher than in the AG genotype, and the rs12149545 AA genotype of TC and LDL-C levels were higher than in the GG genotype; (4) perfect Linkage Disequilibrium was observed for two sets of two SNPs: rs3764261 and rs12149545; rs711752 and rs708272. (5) Using SHEsis software analysis, the five A/T/A/A/T/C/A/G, A/T/A/A/T/T/G/A, G/G/A/G/C/C/G/G, G/G/C/G/C/C/A/G and G/G/C/G/C/T/G/G haplotypes were between dyslipidemia group and control group statistically significantly different (p < 0.05 in each case). The polymorphism of CETP genes rs708272, rs3764261, rs1800775, rs711752, rs12149545 was closely related to the dyslipidemia in the Xinjiang Uyghur and Kazakh ethnic groups; and the rs708272 T, rs3764261 T, rs711752 A, and rs12149545 A alleles could reduce risk of dyslipidemia in the Uyghur and Kazakh populations, however, the rs1800775 C allele showed risk factors.

How university students view human papillomavirus (HPV) vaccination: A cross-sectional study in Jinan, China

The acceptability of HPV vaccination among university students in China is not well understood. Our study was of cross-sectional study design. We collected a questionnaire about socio-demographic characteristics, knowledge of, attitude toward and acceptability of HPV vaccination. A total of 351 students were included in data analyses, among whom 47.6% were males and 70.0% aged 19-21. Only 10.3% had previously heard of HPV and 5.4% HPV vaccine. Male and female students were equally likely to accept HPV vaccine (71.8 vs 69.4%, p = 0.634) and recommend it to sexual partners (73.1 vs 76.7%, p = 0.441). The great majority of students could only afford RMB 300 (USD 50) or less for HPV vaccination. HPV vaccination acceptance was associated with being in year-one (Adjusted odds ratio (AOR)  = 3.78, 95% confidence interval (CI): 2.12-6.75), being from a key university (AOR = 1.88, 95%CI: 1.07-3.31), having heard of HPV-related morbidities (AOR = 1.88, 95% CI: 1.05-3.35), being concerned about HPV-related morbidities (AOR = 2.23, 95% CI: 1.16-4.27) and believing the vaccine should be given before first sexual contact (AOR = 2.44, 95% CI: 1.38-4.29). Female students were more likely to anticipate a late uptake of HPV vaccination (p = 0.002). The relatively lower levels of HPV knowledge but higher levels of vaccine acceptance among undergraduates highlighted the need for education on the roles of sexual behaviors in HPV transmission.

Association of Inflammation with Metabolic Syndrome among Low-Income Rural Kazakh and Uyghur Adults in Far Western China

This study focused on low-income rural and nomadic minority people residing in China's far west and investigated their relationship between inflammatory markers (IL-6, hsCRP, FFA, and adiponectin) and MS and ethnic differences. And it found that improving behavioral lifestyle by education or using drugs to control inflammation may prevent MS. These observations may benefit low-income populations.

Human papillomavirus infection correlates with inflammatory Stat3 signaling activity and IL-17 level in patients with colorectal cancer

Background

Colorectal cancer (CRC) is a major burden of public health and healthcare worldwide. Microbiota has been suggested in promoting chronic inflammation in the intestine which, in turn, promotes tumor development. This study focuses on possible correlations of human papillomavirus (HPV) infection with proinflammatory Stat3 signaling activities and the resulting levels of its downstream proinflammatory cytokine IL-17 in CRC patients.

Methods

HPV was examined using HPV Genotyping Chip technology and constitutively active Stat3 (p-Stat3) and IL-17 levels were tested using immunohistochemistry (IHC) in paraffin-embedded cancerous and adjacent normal tissues (ANT) from a cohort of 95 CRC patients. Correlation analyses were performed between HPV infection and clinicopathological characteristics, Stat3 activities and IL-17 levels among these CRC patients.

Results

Three major findings were observed: (1) HPV infection existed in a high rate of CRC cases (48.4%, 46/95), of which 45 cases (45/46, 97.8%) were high-risk HPV16-positive and only one case was HPV53-positive. (2) HPV infection correlated with poorer clinical stages (III+IV) of CRC. (3) HPV infection strongly correlated with both constitutively higher Stat3 activities (P<0.01) and higher IL-17 levels (P<0.01) only in CRC tissues but not in ANT tissues.

Conclusions

HPV infection is common in CRC patients suggesting potentially preventive effectiveness of HPV vaccination among high-risk young individuals. We have for the first time revealed a tri-lateral relationship among HPV infection, constitutive Stat3 activity and IL-17 level, whose collaborative act may orchestrate a proinflammatory microenvironment in the colorectum that, in turn, may promote carcinogenesis and possibly facilitate progression of CRC.

Implementing a cervical cancer awareness program in low- income settings in Western China: a community-based locally affordable intervention for risk reduction

BACKGROUND

Some 60 years after introduction of the Papanicolaou smear worldwide, cervical cancer remains a burden in developing countries where >85% of world new cases and deaths occur, suggesting a failure to establish comprehensive cervical-cancer control programs. Effective interventions are available to control cervical cancer but are not all affordable in low-income settings. Disease awareness saves lives by risk-reduction as witnessed in reducing mortality of HIV/AIDS and smoking-related cancers.

SUBJECTS AND METHODS

We initiated a community-based awareness program on cervical cancer in two low-income Muslim Uyghur townships in Kashi (Kashgar) Prefecture, Xinjiang, China in 2008. The education involved more than 5,000 women from two rural townships and awareness was then evaluated in 2010 and 2011, respectively, using a questionnaire with 10 basic knowledge questions on cervical cancer. Demographic information was also collected and included in an EpiData database. A 10-point scoring system was used to score the awareness.

RESULTS

The effectiveness and feasibility of the program were evaluated among 4,475 women aged 19-70 years, of whom >92% lived on/ below US$1.00/day. Women without prior education showed a poor average awareness rate of 6.4% (164/2,559). A onetime education intervention, however, sharply raised the awareness rate by 4-fold to 25.5% (493/1,916). Importantly, low income and illiteracy were two reliable factors affecting awareness before or after education intervention.

CONCLUSIONS

Education intervention can significantly raise the awareness of cervical cancer in low-income women. Economic development and compulsory education are two important solutions in raising general disease awareness. We propose that implementing community-based awareness programs against cervical cancer is realistic, locally affordable and sustainable in low-income countries, which may save many lives over time and, importantly, will facilitate the integration of comprehensive programs when feasible. In this context, adopting this strategy may provide one good example of how to achieve "good health at low cost".

Ethnic differences in prevalence of general obesity and abdominal obesity among low-income rural Kazakh and Uyghur adults in far western China and implications in preventive public health

BACKGROUND

The global pandemic of obesity has become a disastrous public health issue that needs urgent attention. Previous studies have concentrated in high-income urban settings and few cover low-income rural settings especially nomadic residents in mountain areas. This study focused on low-income rural and nomadic minority people residing in China's far west and investigated their prevalence and ethnic differences of obesity.

METHODS

A questionnaire-based survey and physical examination of 8,036 individuals were conducted during 2009-2010, using stratified cluster random sampling method in nomadic Kazakhs and rural Uyghur residents (≥ 18 years old) in 18 villages, Xinjiang, China, about 4,407 km away from capital Beijing. Obesity was defined by BMI and WC.

RESULTS

The overall prevalence of general and abdominal obesity in Kazakh adults were 18.3% and 60.0%, respectively and in Uyghur, 7.6% and 54.5%, respectively. Female's prevalence of obesity was higher than male's for general obesity (45-54 age group in Uyghur, P = 0.041) and abdominal obesity (≥ 55 years in Kazakhs, P(55 ∼) = 0.010, P(65 ∼) = 0.001; and ≥ 18 years in Uyghurs, P<0.001). Kazakh's prevalence of obesity was higher than Uyghur's (general obesity: ≥ 35 years, P<0.001; abdominal obesity: ≥ 25 years in males and ≥ 65 years in females, P<0.01). The prevalence of obesity increased after 18 years old and subsequently decreased after 55 years old. Meat consumption, older age, and female gender had a higher risk of obesity in these two minorities.

CONCLUSIONS

Both general and abdominal obesity were common in rural ethnic Kazakhs and Uyghurs. The prevalence rates were different in these two minorities depending on ethnicity, gender, and age. Kazakhs, females and elderly people may be prioritized in prevention of obesity in western China. Because of cost-effectiveness in measuring BMI and WC, we recommend that BMI and WC be integrated into local preventive policies in public health toward screening obesity and related diseases in low-income rural minorities.

Overweight and obesity among low-income Muslim Uyghur women in far western China: correlations of body mass index with blood lipids and implications in preventive public health

BACKGROUND

The pandemic of obesity is a global public health concern. Most studies on obesity are skewed toward high-income and urban settings and few covers low-income populations. This study focused on the prevalence of overweight and obesity and their correlations with blood lipids/metabolites/enzymes (bio-indicators) in a rural community typical of low-income in remote western China.

METHODS

This study was performed in a Muslim ethnic Uyghur rural community in Kashi Prefecture of Xinjiang, about 4,407 km (2,739 miles) away from Beijing. Body mass index (BMI) and major blood bio-indicators (25 total items) were measured and demographic information was collected from 1,733 eligible healthy women aged 21 to 71 yrs, of whom 1,452 had complete data for analysis. More than 92% of the women lived on US$1.00/day or less. According to the Chinese criteria, overweight and obesity were defined as BMI at 24 to <28 kg/m(2) and at ≥ 28 kg/m(2), respectively.

RESULTS

The average BMI among these low-income women was 24.0 ± 4.0 (95% CI, 17.5-33.7) kg/m(2). The prevalence of obesity and overweight was high at 15.1% and 28.9%, respectively. Among 25 bio-indicators, BMI correlated positively with the levels of 11 bio-indicators including triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TCHOL), glucose (GLU), and uric acid (UA); but negatively with the levels of 5 bio-indicators including high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A/B (APO A/B).

CONCLUSIONS

This is the first investigation reporting overweight and obesity being common in low-income Muslim Uyghur women, whose BMI correlates with several important blood bio-indicators which are risk factors for diabetes and cardiovascular diseases. These findings may help make preventive public health policies in Uyghur communities. To prevent diabetes and cardiovascular diseases in low-income settings, we therefore propose a cost-effective, two-step strategy first to screen for obesity and then to screen persons with obesity for diabetes and cardiovascular diseases.